From the Guidelines
The recommended management approach for type 2 diabetes involves a comprehensive strategy combining lifestyle modifications and medication, with metformin as the first-line medication, unless contraindicated, as stated in the most recent guideline from the American College of Physicians 1.
Key Components of Management
- Lifestyle modifications, including dietary changes, regular physical activity, and weight loss if overweight
- Medication, starting with metformin, and potentially adding other agents such as SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas, or insulin therapy, based on individual factors
Considerations for Medication Selection
- Individualized assessment of each patient's preferences, glycemic control target, comorbid conditions, and risk for symptomatic hypoglycemia, as recommended by the American College of Physicians 1
- Consideration of the evidence of benefits, harms, patient burden, and cost of medications, as well as the potential for cardiovascular and renal benefits, as discussed in the 2024 standards of care in diabetes 1
Monitoring and Screening
- Regular monitoring of blood glucose levels, with a target HbA1c of less than 7% for most patients
- Regular screening for complications, such as retinopathy, nephropathy, and neuropathy, and managing cardiovascular risk factors, as emphasized in the 2018 ACC expert consensus decision pathway 1
Comprehensive Care
- A person-centered shared decision-making approach, considering the individual patient's needs and preferences, as recommended by the 2024 standards of care in diabetes 1
- Coordination of care with the patient's primary care physician and/or endocrinologist, as suggested by the 2011 AHA/ACCF secondary prevention and risk reduction therapy guideline 1
From the FDA Drug Label
ACTOS is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. The main goal of treating diabetes is to lower your blood sugar to a normal level. High blood sugar can be lowered by diet and exercise, and by certain medicines when necessary.
The recommended management approach for type 2 diabetes includes:
- Diet and exercise as the primary approach to improve glycemic control
- Medicines, such as pioglitazone (ACTOS) or metformin, as an adjunct to diet and exercise when necessary
- Individualized therapy, with the goal of lowering blood sugar to a normal level
- Monitoring, including regular evaluation of HbA1c levels to assess long-term glycemic control 2, 3, 2
From the Research
Management Approach for Type 2 Diabetes
The recommended management approach for type 2 diabetes involves a stepwise program of intensive therapy, including lifestyle modifications and sequential addition of oral antihyperglycemic agents and insulin as necessary 4. This approach aims to lessen microvascular complications and promote a lifestyle that reduces macrovascular complications and comorbidities.
Key Components of Management
- Lifestyle modifications, such as diet and physical activity, play a crucial role in managing type 2 diabetes 5, 6, 7
- Oral antihyperglycemic agents and insulin may be added sequentially to achieve glycemic control 4
- Comprehensive diabetes management should include diabetes education, emphasis on lifestyle modification, achievement of good glycemic control, minimization of cardiovascular risk, and avoidance of drugs that can aggravate glucose or lipid metabolism 8
- Person-centered care and self-care are essential for patients with type 2 diabetes, and professional health education can help modify urbanization-related lifestyle habits 7
Prevention and Risk Reduction
- Lifestyle changes, such as healthy dietary changes and increased physical activity, can prevent type 2 diabetes and reduce the risk of late complications 6
- The Mediterranean dietary pattern can be recommended for the long-term prevention of diabetes 6
- Prevention of type 2 diabetes by lifestyle changes can result in a sustained risk reduction for many years after the active intervention 6