Current guidelines for the management of type 2 diabetes

This summary outlined the current recommendations for the management of type 2 diabetes. The authors concluded that the management strategies available differ for each individual.

Type 2 diabetes (T2D) is a progressive disease. While it may be controlled at first with lifestyle changes, such as diet and exercise, eventually medications to lower glucose (sugar) levels are needed. Many with T2D will also eventually need insulin therapy in order to control blood glucose levels. Increased blood glucose can lead to complications such as kidney disease or cardiovascular disease (CVD), so effective treatments are essential.

There are many strategies available for the management of T2D. The American Association of Clinical Endocrinologists and American College of Endocrinology have published their 2016 guidelines as to how T2D should be managed.

This statement aimed to summarize the current management strategies for T2D. They recommend that strategies chosen should be individualized based on the characteristics (such as initial weight, blood pressure, average blood glucose levels) of the patient.

Good control of blood glucose levels is recommended in order to reduce complications such as kidney disease and eye disease. These target HbA1c (average blood gluocse level over 3 months) should depend on the overall health of the patient.

Lifestyle therapy may be sufficient for some patients. This includes medical nutrition therapy, behavioral support and quitting smoking. Patients should aim to have a healthy weight. Patients should maintain this weight by eating plant-based foods which are high in unsaturated fatty acids (includes ‘good’ fats obtained from fish and nuts).

It is recommended that T2D patients get 150 minutes of regular physical activity each week. In addition, patients should get a sufficient amount of sleep (approximately 7 hours each night) to reduce the CVD risk. Sleep deprivation can reduce the ability of insulin to work even further and can increase blood pressure.

The first glucose-lowering treatment should ideally be metformin (Glucophage). This may be combined with other types of glucose-lowering medications if necessary. However, patients treated with 2 blood glucose-lowering agents who continue to have an HbA1c greater than 8% would benefit from insulin therapy. Initially, patients may inject a single dose of insulin once daily to reduce glucose levels over 24 hours. However, patients with uncontrolled high blood glucose levels may require insulin injections at mealtime also.

All patients should aim to reduce blood pressure and blood lipid levels (such as choloesterol) to reduce the CVD risk.

Prediabetes (when blood glucose levels are higher than normal but not high enough to be considered T2D) increases the risk of developing T2D. There are currently no drugs approved for the treatment of prediabetes. Patients with prediabetes are primarily encouraged to lose weight in order to reduce the T2D risk.

This statement concluded that there are various options available for each individual patient. However, these guidelines are only suggestive and do not replace a clinician’s opinion.