In a nutshell
This article provided guidelines for the management of hyperglycemia (high blood glucose levels) in patients with Type 2 diabetes (T2D).
Some background
The goals of T2D treatment are to prevent or delay complications and maintain a patient’s quality of life. Management of hyperglycemia and cardiovascular (heart and blood vessels) risk factors are essential. Patient-centered care is also important. This includes lifestyle interventions and helping patients adhere to therapy. Irregular medication use and stopping treatment can increase the risk of diabetes complications, such as cardiovascular disease (CVD).
Methods & findings
Metformin (Glucophage) is recommended as a first-line treatment for patients with T2D. However, most patients eventually require second-line glucose-lowering medications for better glycemic (blood glucose) control. Adding glucose-lowering medications to metformin is recommended.
The choice of glucose-lowering medication should be based on whether a patient has CVD, heart failure, or chronic kidney disease. These conditions affect 15 to 25% of all patients with T2D. For patients with CVD and heart failure, sodium-glucose cotransporter 2 (SGLT2) inhibitors such as empagliflozin (Jardiance) are recommended. This type of treatment helps the kidneys remove glucose from the body through the urine.
For patients with chronic kidney disease with or without CVD, SGLT2 inhibitors are recommended. GLP-1 agonists such as liraglutide (Victoza) may also be used. This type of treatment lowers lower blood glucose levels by increasing insulin secretion from the pancreas.
Some patients with severe hyperglycemia may need more intense treatment. Insulin therapy added to glucose-lowering medications has been shown to be effective.
Lifestyle interventions such as dietary changes and physical exercise are safe and effective for improving glycemic control in T2D. Individualized dietary programs can help reduce the risk of complications and keep eating pleasurable. A wide range of physical activities, including walking, swimming, gardening, and yoga, can significantly reduce HbA1c (average blood glucose over 3 months) levels. These activities can be recommended for patients with CVD or neuropathy (numbness or tingling in the hands and feet).
For patients who are overweight or have obesity, dietary restriction with counseling sessions are recommended. However, dietary changes plus physical exercise improves hyperglycemia more than either alone. Weight loss medications may also be recommended for these patients. If these approaches are unsuccessful, bariatric (weight loss) surgery may be recommended.
The bottom line
This article provided updated guidelines for the management of hyperglycemia in patients with T2D.
Published By :
Diabetologia
Date :
Oct 05, 2018
