In the meantime, decisions on therapy should be based on individual factors exhibited by patients.
While the A1c are dropping, but the wide glucose swings are still taking place and the people with DMT2 are still not at 100% of the care standards and many preventinve isssues are being missed.
The daily self monitoring, may help people learn more about avoiding the glucose roller coaster. The hospitals in my area have discontinued the DM education clinic, the susbstitution telephonic line support has not been nearly as effective as the previous education program. There is also support online, and maybe in the future folks will avoid the pitfalls, but the current patients without the PC skills, it becomes another barrier to solve their health problems. Diet, exercise, and education remain the foundation of any type 2 diabetes treatment program. Ultimately, many patients will require insulin therapy alone or in combination with other agents to maintain glucose control. The American Diabetes Association and the European Association for the Study of Diabetes have updated guidelines on the management of hyperglycemia in nonpregnant adults with type 2 diabetes. The novel position statement on the management of hyperglycemia in type 2 diabetes was necessary because since the last similar treatment algorithm, which is more than 3 years old, a lot of new insights have been generated that required an update. According to the ADA, to reduce the incidence of macrovascular disease, HbA1c should be lowered to less than 7% in most patients. For strong recommendations in favour (or against) certain diabetes medications, the evidence is not strong enough; choices and preferences will differ with different patients, their characteristics and attitudes. Several therapeutic options were discussed, including lifestyle interventions to change physical activity levels and food intake; oral agents and noninsulin injectables, as well as insulin. The second step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-1) receptor agonist, it can be a thiazolidinedione, it can be a sulfonylurea agent, or it could be basal insulin. If a patient needs a more intensive insulin regimen, then it is recommended to add 1 or 2 - maybe even 3 - doses of mealtime insulin. The position statement lists all commonly used medications with all their properties (positive and negative), and gives all the information to make good choices based on priorities (ie, avoiding hypoglycemia at all costs) and preferences. Overall, comparative evidence for antihyperglycemic treatment of type 2 diabetes is lacking, and there is a considerable need for high-quality, comparative-effectiveness research on costs and outcomes important to patients, including quality of life and the avoidance of life-limiting complications such as cardiovascular disease. Because of the rapid change in lifestyle in China, there is concern that diabetes may become epidemic. A nationally representative sample of 46,239 adults, 20 years of age or older, from 14 provinces and municipalities participated in the study. These results indicate that diabetes has become a major public health problem in China and that strategies aimed at the prevention and treatment of diabetes are needed. In an editorial comment in the European Heart Journal, some opinion leaders indicate what might be the reasons for the failure of the dal-HEART programme.Both the on-treatment vascular effects and the underlying molecular mechanism causing increased HDL-c are important in determining the vascular effects of an HDL-c raising therapy.
The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study assessed how to manage diabetes in children and adolescents. The China National Survey of Chronic Kidney disease was a cross-sectional study to evaluate the prevalence of CKD and associated factors in Chinese adults between 2007 and 2010.CKD has become an important public health issue in China, maybe as a consequence of increased diabetes and hypertension.
DPP-4 inhibitors can be used as second line treatment in patients with type 2 diabetes who do not achieve their glycaemic targets with metformin alone.
The study was set up to determine all cause mortality and deaths from cardiovascular events related to intensive glucose lowering treatment in people with type 2 diabetes. In GPRD data, current use of sulphonylureas only (with active or inactive metabolites) was associated with an increased risk of hypoglycaemic events, as compared with current use of metformin.
Recent outcome trials of novel antidiabetic drugs shed new light on why diabetes patients develop heart disease. Out of 18 biomarkers, Lp-PLA2 and adiponectin were independently associated with a decreased risk for T2DM. In females with gestational diabetes, the future risk of developing type 2 diabetes depends on certain pregnancy-related and maternal factors that could be used for postnatal counselling. Diabetes (high blood sugar) has reached epidemic proportions in America, we must be very alert to the signs and symptoms, and if you have them, please see your health care professional. People with prediabetes have glucose levels that are higher than normal but not high enough yet to indicate diabetes. Normally your body produces a hormone called insulin to help your cells use the energy (glucose) found in food. If you have prediabetes, you’re at high risk of developing type 2 diabetes as well as the serious medical problems associated with diabetes, including heart disease and stroke. To determine if you have prediabetes, your doctor can perform one of three different blood tests: the fasting plasma glucose (FPG) test, the oral glucose tolerance test (OGTT) or the Hemoglobin A1C (or average blood sugar) test.
The good news is there are simple measures you can take to reduce the risk of developing diabetes, these measures can play a significant role in early diagnosis. The following points highlight important actions you can take to help reduce diabetes risk.
Disclaimer: All content on this website is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation.
The majority of patient's diets are rich in fats and low in carbohydrates and fibre 'western diet'. Once the diagnosis established patients need information to help them understand the RISKS associated with diabetes and to help them make the appropriate lifestyle changes particularly with regard to diet and exercise. PRACTICE POINTThirsty patients often drink sweet juice to relieve thirst - simple advice on changing to low calorie drinks can dramatically reduce blood glucose.
The following practical advice can be given initially to patients before their dietetic review. Dietetic referral is mandatory for instruction on healthy eating, lifestyle change and probable calorie restriction. The majority of patients with Type 2 diabetes will ultimately require oral agents and many will eventually require insulin therapy therefore it is worth telling patients this at diagnosis. If after three months diet and lifestyle changes are insufficient to achieve a target HbA1c of < 7% then an oral agent should be introduced.
Initiation of dual therapy on diagnosis may be necessary for those with very high glucose concentrations and symptomatic.
Various mechanisms of action have been proposed but it is thought that its main metabolic effect is mediated by an inhibition of hepatic gluconeogenesis and decrease hepatic output. The main mechanism of action of this group of drugs is to lower blood glucose by stimulating insulin secretion and hence their association with hypoglycaemia.
Glimeperide 1 mg up to 4 mgs once daily may be useful in patients with adherence problems who find difficulty with multi-dosing. Postprandial glucose regulators such as Nateglinide or Repaglinide are second line drugs and not recommended without specialist consultation. Substitution of a Glitazone for metformin or sulphonylurea for those already on combination therapy is not recommended, as there is no evidence to support an improvement on glycaemic control.
The following paragraph has been taken from a press release from the European Medicines Agency (18th October 2007) following a review of this latest evidence. Having assessed all available data, the CHMP concluded that the benefits of both rosiglitazone and pioglitazone in the treatment of type 2 diabetes continue to outweigh their risks.
Remember peripheral edema and heart failure may be a side effects of glitazone therapy hence they are contraindicated if any history of liver disease or heart failure. PRACTICE POINTThese agents take 4-6 weeks to attain maximal effect - do not expect an immediate response. Post prandial glucose regulators include Nateglinide or Repaglinide and are second line drugs. Acts by inhibiting glucose absorption and results in carbohydrate delivery to large bowel causing wind and cramps in a significant proportion of patients.
Sitagliptin inhibits dipeptidyl peptidase 4 (DPP-IV) and thus prevents the degradation of incretin hormones, which are released from gut cells in response to a meal. The effects on glucose control seen with Exenatide treatment are thought to be due to several properties that are similar to those of the naturally occurring incretin hormone GLP-1. Animal studies have shown that Exenatide helped preserve and form new beta cells, the insulin-producing cells in the pancreas, which fail as type 2 diabetes progresses.
Exendin-4 was initially isolated from the venom found in the saliva of a poisonous lizard found in North America, known as the Gila monster. Unlike most other oral hypoglycaemic drugs which work by a single mechanism, exendin-4 works by several mechanisms: it stimulates insulin secretion, slows emptying of the stomach and inhibits production of glucose by the liver. Fonseca, MD, has indicated to Physician’s Weekly that he has received research support (for Tulane University) in the form of grants from Novo Nordisk, sanofi-aventis, Eli Lilly, Daiichi Sankyo, Pamlabs, Reata, and Halozyme.
With the influx of new therapies, it can sometimes be challenging for clinicians to integrate these new therapies into treatment regimens. Since that time, more information on the benefits and risks of glycemic control has emerged.
On the basis of findings from ACCORD and other studies, an A1C goal has been set at 7% in general, but with some individualization.
These include willingness to self-inject, risk of hypoglycemia, or need for weight loss, among others. Fonseca says the new guidelines may be easier for physicians to implement because they provide greater flexibility in patient care. Type 2 diabetes: assessing the relative risks and benefits of glucose-lowering medications. Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes. Current antihyperglycemic treatment guidelines and algorithms for patients with type 2 diabetes mellitus.
Combination therapy with an additional 1–2 oral or injectable agents is reasonable, aiming to minimize side effects where possible. The update is based on new evidence of risks and benefits of glycemic control, evidence on safety and efficacy of new drug classes, the withdrawal and restriction of other drug classes and the increasing need for a more patient-centered approach to care.
However, data from type 2 diabetes cardiovascular trials have demonstrated that not all patients benefit from aggressive glucose maintenance, again pointing toward a more individualized approach to treatment. In contrast to previous statements, the present one is based on a patient-centered approach. According to the guidelines, when it comes to prescribing oral agents and noninsulin injectables, agent- and patient-specific properties, such as dosing frequency, side effect profiles, cost and other benefits, are often used to guide drug selection. Anticipated glucose-lowering effects should be balanced with the convenience of the regimen, in the context of an individual’s specific therapy goals. We conducted a national study from June 2007 through May 2008 to estimate the prevalence of diabetes among Chinese adults.
With diabetes, either your body doesn’t make enough insulin or doesn’t efficiently use the insulin it does produce. The pancreas may not be able to produce enough insulin after a meal to “clear” the incoming glucose from the blood, or cells may be insulin resistant. With pre-diabetes, you are at a 50% higher risk of heart disease and stroke than someone who does not have pre-diabetes. While the general rule is to have an annual visit, if you are overweight, have high blood pressure, high blood glucose or even high cholesterol, you may want to consider visiting your doctor every 6 months to have your numbers checked and discuss any health concerns. For instance, blood glucose (A1C) should be less than 7% and can be checked by your doctor at least twice a year.
Use of this website and the information contained herein does not create a doctor-patient relationship. Diet and low levels of physical activity are the major causes of obesity and contributing factors to diabetes. Drugs used to treat type 2 diabetes aims to correct the underlying abnormality, namely insulin resistance (metformin, glitazones) and insulin secretion (sulphonlyureas). Metformin has been shown to reduce blood glucose concentration by approximately 25% with a greater effect on postprandial readings. The glucose lowering effect is mediated by activation of the PPARχ receptor, which results in, increased peripheral glucose disposal and decreased hepatic glucose output and subsequent decreased peripheral insulin resistance. It is also suggested that Glitazone therapy be discontinued after 12 weeks if there is no observed benefit.
All patients on glitazone treatment should be reviewed to ensure therapy is appropriate and within the product license. Do not use Rosigltazone in patients with pre-exsisting cardiovascular disease or PVD or in the elderly. Regular monitoring of liver function is required and outlined in the BNF (at baseline and every 2 months for the first year).
It gives effective control of post prandial hyperglycaaemia but is poorly tolerated by most patients. GIP and GLP-1 (Glucagon like peptide) increase insulin release in the presence of elevated glucose thereby decreasing the post meal rise in glucose concentration and reducing fasting blood glucose. These actions include stimulating the insulin response in response to glucose and preventing glucagon (a hormone which raises blood sugar) release after meals.
New guidelines and position statements from well-respected organizations can assist clinicians, but these documents evolve over time based on new information. In addition, there is new evidence on the efficacy and safety of several new drug classes as well as the withdrawal and the restriction of others.
The new guidelines on managing hyperglycemia in type 2 diabetes are less prescriptive and more patient-centered, according to Dr. These curricula should offer information on dietary interventions and emphasize the importance of increased physical activity and weight management. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).
The authors recommend combination therapy with the addition of one to two oral or injectable agents, with the goal of reducing side effects when possible.
The prevalence of diabetes was higher among urban residents than among rural residents (11.4% vs. Most people with prediabetes don’t have any symptoms, but they are considered to be at high risk for developing heart disease. When glucose builds up in the blood, it can damage the tiny blood vessels in the kidneys, heart, eyes, and nervous system.
When cells are insulin resistant, they won’t allow the insulin to escort glucose from the bloodstream into them. This may be a wake-up call as many who are diagnosed with type 2 experience little or no symptoms.
Other factors such as lifestyle habits and family health history should be reviewed to learn how you can adopt necessary changes to reduce diabetes risk. Always consult with your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.
A good starting point in the management of type 2 diabetes is dietary modification with a reduction in energy intake promoting weight loss and alleviation of diabetic symptoms. It does not tend to lower blood glucose reading below normal and thus the risk of hypoglycaemia is minimal.
The second generation sulphonlyureas such as glibenclamide and glipizide have shorter half-life's that for example chlorpropamide or tolbutamide and hence of greater importance when hypoglycaemia is a side effect. Troglitazone was the first drug in this class to be introduced however it was withdrawn from the market due to serious hepatotoxic effects.
In fact Pioglitazone was found to have a significantly lower risk of death, myocardial infarction, or stroke among a diverse population of patients with diabetes.
In addition, the combination of rosiglitazone and insulin should only be used in exceptional cases and under close supervision.
They are possibly advantageous in the avoidance of hypoglyacemia and control of post prandial glucose excursions particularly in the elderly where hypoglycaemia is a concern. Furthermore, experts are suggesting that greater attention be paid to moving toward approaches to care that are more individualized and patient-centered. The material on this site is for informational purposes only, and is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. Insulin therapy, whether alone or in combination, will ultimately be required to maintain glucose control for many patients. It signals the likely onset of a more serious condition and can begin the process of doing damage to your heart as well as other organs such as the kidneys, eyes, and nervous system. Risk factors for both conditions are the same while they are both preventable with weight management, regular exercise, and healthy eating habits. Regular exercise in conjunction with calorie restriction will enhance weight loss but must be tailored to the individual.
Currently there are two glitazones licensed for use in the UK namely Rosiglitazone and Pioglitazone. The position statement by the Association of British Clinical Diabetologists (ABCD) advocates the addition of a glitazone to metformin as a second line agent, as this combination tackles insulin resistance and thus may benefit cardiovascular risk factors and metabolic syndrome. Serious heart failure is increased by pioglitazone, although without an associated increase in mortality (JAMA Volume 298(10), p 1180¡V1188). These changes will be introduced in forthcoming regulatory procedures for rosiglitazone-containing medicines. This drug are currently not on the BJF but may be used in special situations where the clinician feels that benefit may be derived from its use.
Studies have shown that patients receiving Exenatide achieve weight loss in the region of 2.5kg, whereas those treated with insulin gain weight to a similar degree.
It is not licensed for combination with glitazones (Rosiglitazone or Pioglitazone) or insulin. In addition, the American Diabetes Association updates its overall standards of care every January.
In an effort to make the guidelines more patient-centric, there is no “onesize- fits-all” decision pathway. Over the past 10 to 15 years, A1C levels have been dropping, and we’re also seeing lower rates of diabetes-related blindness, retinopathy, dialysis, and amputation.
The prevalence of isolated impaired glucose tolerance was higher than that of isolated impaired fasting glucose (11.0% vs. Furthermore weight loss will have a positive effect on blood pressure (BP) and lipid profile thus favorably altering the cardiovascular risk profile associated with type 2 diabetes. Metformin is the drug of first choice in all patients with diabetes to which a sulphonlyurea or pioglitazone or sitagliptin can be added if it fails to achieve good glycaemic control. However given that the plasma levels of most short acting sulphonlyureas will have fallen to a low trough before breakfast it may be sensible to advise taken the dose 30 minutes before breakfast and subsequent doses with meals. No changes to the prescribing information for medicines containing pioglitazone were considered necessary.
However, they do not lower the HbA1c any more than exsisting therapies, have cost implications and limited long term safety data. Other factors affecting treatment plans include specific symptoms, hypoglycemia risk, comorbid conditions, weight, race and ethnicity, gender, and lifestyle (Table 1). However, while these points are encouraging, many patients with type 2 diabetes are still developing these outcomes. Smoking poses a significant cardiovascular risk and therefore must be discouraged in all diabetic patients.
A sulphonlyurea would be the drug of choice in those who are intolerant of metformin and as add on therapy if Metformin alone fails to achieve adequate control. Pioglitazone has recently been licensed for use with insulin Scottish Medicines Consortium pioglitazone (Actos).
Gliclazide, Glipizide, Glimepiride) in addition to Exenatide, may suffer from hypoglycaemia.
The SMC has accepted Exenatide for restricted use for the treatment of type 2 diabetes mellitus.
Homeopathic management of diabetes|
Diabetes mellitus type 2 side effects 0.5