What is the recommended treatment plan for patients with diabetes?

From the Guidelines

The recommended treatment plan for patients with diabetes involves a comprehensive approach tailored to the individual's specific type of diabetes and health status, with metformin as the first-line medication for type 2 diabetes and insulin therapy for type 1 diabetes, as supported by the most recent guidelines 1.

Key Components of Diabetes Treatment

• For type 2 diabetes, metformin is typically the first-line medication, starting at 500mg once or twice daily and potentially increasing to 1000mg twice daily as tolerated, due to its efficacy, safety, and potential to reduce cardiovascular events and death 1.
• Lifestyle modifications are essential, including a balanced diet limiting refined carbohydrates, regular physical activity (150 minutes of moderate exercise weekly), and maintaining a healthy weight, as these factors can significantly impact glycemic control and overall health 1.
• Blood glucose monitoring is crucial, with target fasting levels of 80-130 mg/dL and post-meal levels below 180 mg/dL, to prevent complications associated with chronic hyperglycemia 1.
• For type 1 diabetes, insulin therapy is mandatory, usually involving multiple daily injections or an insulin pump, with a focus on matching prandial insulin doses to carbohydrate intake, preprandial blood glucose levels, and anticipated activity level, as well as using insulin analogues to reduce hypoglycemia risk 1.

Regular Health Check-ups and Additional Medications

• Regular health check-ups should include HbA1c testing every 3-6 months (target generally <7%), annual eye and foot examinations, and kidney function tests, to monitor disease progression and adjust treatment plans as needed 1.
• Additional medications may be necessary based on cardiovascular risk, kidney function, and glucose control, including SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, or sulfonylureas, with a focus on minimizing side effects and maximizing efficacy 1.

Patient-Centered Approach

• A patient-centered approach should guide the choice of pharmacologic agents, considering factors such as efficacy, cost, potential side effects, and patient preferences, to ensure that treatment plans are tailored to individual needs and values 1.

From the FDA Drug Label

In a randomized, controlled clinical study (Study D), pediatric patients (age range 6 to 15 years) with type 1 diabetes (n=349) were treated for 28 weeks with a basal-bolus insulin regimen where regular human insulin was used before each meal. Insulin Glargine was administered once daily at bedtime and NPH insulin was administered once or twice daily. In a randomized, controlled clinical study (Study E) in 570 adults with type 2 diabetes, Insulin Glargine was evaluated for 52 weeks in combination with oral antidiabetic medications (a sulfonylurea, metformin, acarbose, or combinations of these drugs). Insulin Glargine administered once daily at bedtime was as effective as NPH insulin administered once daily at bedtime in reducing HbA1c and fasting glucose (Table 11).

The recommended treatment plan for patients with diabetes involves the use of Insulin Glargine in combination with other medications, such as oral antidiabetic medications or regular human insulin.

• The dosage of Insulin Glargine should be adjusted to achieve a target fasting plasma glucose ≤100 mg/dL.
• Patients with type 1 diabetes may be treated with a basal-bolus insulin regimen, where Insulin Glargine is administered once daily at bedtime and regular human insulin is used before each meal.
• Patients with type 2 diabetes may be treated with Insulin Glargine in combination with oral antidiabetic medications, with the goal of reducing HbA1c and fasting glucose levels 2.

From the Research

Treatment Plan for Patients with Diabetes

The recommended treatment plan for patients with diabetes involves a combination of lifestyle interventions and medication.

• Lifestyle interventions, such as diet and physical activity, have been shown to be effective in achieving diabetes remission, reducing weight, and improving quality of life in patients with type 2 diabetes mellitus 3.
• The contents of lifestyle interventions should focus on diet and physical activity, including low-energy diet, low carbohydrate diet, Mediterranean diet, moderate-intensity aerobic and resistance physical activity, walking, and maintaining habitual physical activity 3.
• Healthy eating and increased physical activity can prevent or delay the onset of diabetes mellitus and facilitate diabetes management, with current guidelines recommending long-term weight loss of 5% to 7% of body weight and 150 minutes of at least moderate-intensity physical activity per week 4.

Medication

• Metformin is the first choice of glucose-lowering medicines for most patients with type 2 diabetes, while sulphonylureas have proven benefits in long-term trials 5.
• Insulin is required in patients with symptoms of insulin deficiency, and glucagon-like peptide 1 agonists and sodium-glucose co-transporter 2 inhibitors provide some assistance in weight loss as well as improving blood glucose control 5.
• Dipeptidyl peptidase 4 inhibitors provide an alternative to metformin and sulphonylureas, especially when side effects of those drugs limit their use 5.
• Glucagon-like peptide-1 receptor agonists are available for the treatment of patients with type 2 diabetes, and their role in the management of patients with diabetes can help guide the selection of the most suitable agent for individualized treatment 6.

Alternative Agents

• Alternative agents, such as metformin, alpha-glucosidase inhibitors, pioglitazone, GLP-1 agonists, DPP-IV inhibitors, and SGLT-2 inhibitors, can be used in addition to insulin therapy for patients with type 1 diabetes mellitus, and have been shown to reduce insulin resistance and prevent or deter weight gain 7.
• These agents can help reduce hemoglobin A1c, decrease insulin doses, and have favorable effects on weight, with limited evidence of hypoglycemia 7.