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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? Diabetic retinopathy is the most common diabetic eye disease caused by changes in the retinal blood vessels. In diabetic retinopathy, the retinal blood vessels may swell and leak in some patients, while in others new vessels can grow on the surface of the retina too, resulting in loss of light sensitivity of retina, affecting vision.
As the name indicates, people with diabetes (both type 1 and type 2) are at risk of developing diabetic retinopathy. Pregnancy can precipitate the diabetic retinopathy therefore pregnant diabetic women are advised to undergo eye examinations in each trimester. People with Down’s syndrome having 3 copies of chromosome 21 almost NEVER acquire diabetic retinopathy! If you experience any of the symptoms of diabetic retinopathy consult your eye specialist as soon as possible to have a comprehensive eye examination. Note that the above mentioned options simply slow down the progress of disease or may even stop it, but they don’t treat the damage already occurred and can’t reverse it. Low Vision SpecialistsIf you or a loved one have vision loss, call today for a free phone consultation.
Low Vision Specialists Specialists of Maryland and Virginia servicing Annapolis, Baltimore, Bethesda, Columbia, Rockville, Silver Spring, Towson, and other locations. Serving the following areas since 1975 MARYLAND: Annapolis, Baltimore, Bel Air, Bethesda, Bowie, Carney, Cockeysville, Columbia, Crofton, Elkton, Essex, Fallston, Fredrick, Gaithersburg, Glen Burnie, Glenwood, Hampstead, Havre de Grace, Jarrettsville, Kingsville, Laurel, Lutherville, Manchester, Monkton, Parkton, Parkville, Perry Hall, Phoenix, Pikesville, Potomac, Randallstown, Reisterstown, Rockville, Severn, Severna Park, Silver Spring, Sparks-Glencoe,Sparrows Point, Towson, Westminster, and Whitemarsh.
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).


Therefore anyone with diabetes should be vigilant about any vision related changes and issues and get a detailed eye examination regularly every year at least. This is believed to be due to elevated endostatin levels which is an anti-angiogenic protein derived from a collagen located on chromosome 21. Your doctor should take a detailed history, including family history, and do various tests at your eye examination. There are certain other treatments that seem promising but are under trial and development phases.
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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    03.07.2015

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    03.07.2015