From the Guidelines
Diabetes management should prioritize a multifaceted approach including lifestyle modifications, medication adherence, and regular monitoring to minimize morbidity, mortality, and improve quality of life.
Overview of Diabetes
Diabetes is a chronic condition characterized by high blood sugar levels due to either insufficient insulin production (Type 1) or the body's inability to effectively use insulin (Type 2) 1. Management includes regular blood glucose monitoring, medication adherence, and lifestyle modifications.
Type 1 Diabetes Management
For Type 1 diabetes, insulin therapy is essential, typically requiring multiple daily injections or an insulin pump. Common insulins include rapid-acting (Humalog, NovoLog), long-acting (Lantus, Levemir), and intermediate-acting (NPH).
Type 2 Diabetes Management
For Type 2 diabetes, oral medications like metformin (starting at 500mg once or twice daily) are often first-line treatments, potentially combined with other agents such as SGLT-2 inhibitors, GLP-1 receptor agonists, or DPP-4 inhibitors as needed 1.
- Key considerations for Type 2 diabetes management include:
- The use of glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium glucose cotransporter 2 inhibitors (SGLT2i) to reduce cardiorenal events in people living with T2DM at high CV risk.
- Recent guidelines from the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the European Society of Cardiology (ESC) recommend prescribing these agents in such patients.
Lifestyle Modifications
Lifestyle modifications are crucial for all diabetes patients, including:
- A balanced diet low in refined carbohydrates
- Regular physical activity (150 minutes weekly of moderate exercise)
- Weight management
- Smoking cessation
Monitoring and Screening
Regular monitoring of HbA1c levels (target generally <7%) helps assess long-term glucose control 1. Patients should also undergo regular screening for complications affecting the eyes, kidneys, nerves, and cardiovascular system. Diabetes self-management education is vital for understanding the condition and developing skills to effectively manage it daily. The integration of evidence-based practices into clinical decision-making is critical to improve patient outcomes.
From the Research
Diabetes Management
- Diabetes is a chronic disease that requires constant self-management, including balancing medications, blood glucose monitoring, food intake, physical activity, and managing complications 2.
- Lifestyle interventions, such as diet and physical activity, can achieve diabetes remission among patients with type 2 diabetes mellitus 3.
- Techniques to assess and facilitate adherence to lifestyle changes, such as healthy eating and increased physical activity, can be practical in primary care 4.
Lifestyle Interventions
- Lifestyle interventions included in studies were mainly divided into diet-only interventions and diet combined with physical activity interventions 3.
- Diet and physical activity have a significant effect on blood glucose and weight control in patients with type 2 diabetes mellitus 3.
- Consuming low-carbohydrate, balanced meals and eating most carbohydrates early in the day can improve diabetes management 5.
- Postmeal glucose surges can be blunted with moderate exercise 30-60 minutes before the anticipated peak 5.
Medications and Treatment
- The combination of GLP-1 receptor agonists, SGLT-2 inhibitors, and DPP-4 inhibitors can effectively lower HbA1c and FPG in T2DM patients who have poor therapeutic effects on basic insulin combined with metformin/sulfonylureas 6.
- GLP-1 receptor agonists can significantly reduce body weight and basic insulin dosage, while DPP-4 inhibitors and SGLT-2 inhibitors have a lower risk of hypoglycemia 6.
- Current guidelines recommend long-term weight loss of 5% to 7% of body weight and 150 minutes of at least moderate-intensity physical activity per week for most patients with prediabetes and diabetes 4.
Patient Education and Support
- Successful management of diabetes demands constant self-management on the part of the patient, including medical nutrition therapy, physical activity, smoking cessation, and assessment for diabetes distress 2.
- Patients should be assessed and gradually encouraged to work toward lifestyle changes, with long-term goals separated into highly specific short-term outcome goals and achievable behavior targets 4.
- Follow-up contact with patients helps maintain and expand progress by reviewing self-monitored goals, targets, and achievements; finding opportunities to encourage and empower; reviewing slips, triggers, and obstacles; and negotiating further customization of the plan 4.