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Hi, this is Cesar Giral MD, one of the founders of DiabeTV, a virtual place conceived to inspire diabetic people. To fulfill our objectives, DiabeTV has put together an interdisciplinary team that permanently looks for the most recent and advanced information from a variety of fields. NB: We use cookies to help personalise your web experience and comply with Irish healthcare law.
This site contains information, news and advice for healthcare professionals.You have informed us that you are not a healthcare professional and therefore we are unable to provide you with access to this site. Diet, exercise, and education remain the foundation of all type 2 diabetes treatment programmes. After metformin, it is reasonable to consider combination therapy with an additional 1-2 oral or injectable agents with the objective of minimising side-effects where possible. For many patients insulin therapy alone or in combination with other agents will ultimately be required to maintain glucose control.
All treatment decisions, where possible, should take into account the patient’s preferences, needs and values.
Diabetes may be diagnosed based on HbA1c criteria or plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h plasma glucose (2-h PG) value after a 75-g oral glucose tolerance test (OGTT).
For all patients, particularly those who are overweight or obese, testing should begin at age 45 years.


Two primary techniques are available to assess the effectiveness of glycaemic control: Patient self-monitoring of blood glucose (SMBG) or interstitial glucose and A1C. Patients on multiple-dose insulin or insulin pump therapy should perform SMBG prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normoglycaemic, and prior to critical tasks such as driving. Initial therapy: Most patients should begin with lifestyle changes – healthy eating, weight control, increased physical activity, and diabetes education. Advancing to dual combination therapy: If the HbA1c target is not achieved after ~3 months with metformin, there are six drug choices including a second oral agent (sulfonylurea, TZD, DPP-4 inhibitor, or SGLT2 inhibitor), a GLP-1 receptor agonist, or basal insulin. Advancing to triple combination therapy: Evidence suggests that there is some advantage in adding a third noninsulin agent to a two-drug combination not achieving the glycaemic target. Do you agree that private hospitals should be paid via the NTPF to cut public hospital waiting lists? Through scientific information and practical tips we hope to convince you that diabetes is not an obstacle to enjoy a healthy, long lasting, and productive life. We hope to improve significantly your capabilities to exert a strict control over your diabetes and prevent its complications.
Diabetes may be identified in seemingly low risk individuals who happen to have glucose testing, in symptomatic patients, and in higher-risk individuals who are tested because of a suspicion of diabetes.
When lifestyle efforts alone have not achieved or maintained glycemic goals, metformin monotherapy should be added at, or soon after, diagnosis (in patients intolerant, or with contraindications for, metformin, select initial drug from other treatment options).


Shared decision making with the patient is important to help in the selection of therapeutic option.
Since diabetes is associated with progressive beta-cell loss, many patients, especially those with long-standing disease, will ultimately need to be transitioned to insulin. The choice is based on patient and drug characteristics, with the over-riding goal of improving glycaemic control while minimising side-effects.
Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes.
Position statement of the American Diabetes Association and the European Association for the Study of Diabetes.
In using triple combinations the essential consideration is obviously to use agents with complementary mechanisms of action.



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Comments

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    29.12.2013

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    29.12.2013