Treating Persistent Hyperglycemia in Patients with Type 2 Diabetes Mellitus

Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise and weight reduction when appropriate. Oral monotherapy is often initiated as first-line therapy, though insulin may be indicated for initial treatment in some patients. Regardless of the choice of initial therapy, most patients will require continuous treatment in order to maintain normal or near-normal glycemic levels. The initial effectiveness of oral medications commonly wane over time, and HbA1c levels gradually climb. For example, data from the United Kingdom Prospective Diabetes Study (UKPDS) showed that after a successful initial response to oral therapy, patients fail to maintain target A1C levels (<7 percent) at a rate of 5 to 10 percent per year. This study also found that 50 percent of patients originally controlled with a single drug required the addition of a second drug after three years; by nine years 75 percent of patients needed multiple therapies to achieve the target hemoglobin A1C (HbA1c) value.

More recent studies, such as Investigators in A Diabetes Outcome Progression Trial (ADOPT), showed similar results with regards to treatment failure with monotherapy.

Join this conversation as Dr Carlos Hamilton, Dr Philip Orlander and Dr Dale Hamilton discuss treatment strategies in type 2 diabetic patients with recurring hyperglycemia.

Related References/Reading:

1. Turner RC et al. Glycemic Control With Diet, Sulfonylurea, Metformin, or Insulin in Patients With Type 2 Diabetes Mellitus. JAMA. 1999;281:2005-2012.Kahn SE et al.
2. Glycemic Durability of Rosiglitazone, Metformin, or Glyguride Monotherapy. N Engl J Med. 2006;355:2427-2443.