Glycemic Control in Type 2 Diabetes Mellitus: Initial Treatment

Treatment of type 2 diabetes begins with efforts to improve lifestyle factors, including diet and exercise. However, lifestyle intervention alone has had limited long-term success in maintaining glycemic goals for most patients with type 2 diabetes, and the majority of patients with type 2 diabetes will require medication over the course of their diabetes.

A 2006 consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) proposes that metformin therapy, in the absence of contraindications, be initiated, concurrent with lifestyle intervention, at the time of diabetes diagnosis. In addition to metformin, other oral medications and insulin are often necessary for maintaining optimal glycemic control. The balance among efficacy in lowering HbA1C levels, side-effects, and costs must be carefully weighed in considering which drugs or combinations to choose. Avoiding insulin, the most potent of all hypoglycemic medications, at the expense of poorer glucose control and greater side-effects and cost, is not likely to benefit the patient in the long-term.

In this conversation, two diabetes experts, Dr Alan Garber and Dr Glenn Cunningham, join Dr Carlos Hamilton to discuss current issues surrounding initial treatment for Type 2 diabetes mellitus.

Related References/Reading:

1. Nathan DM et al. Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy. Diabetes Care. 2006;29:1963-1972.
2. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-986.