What is the recommended initial management of type 2 diabetes?

From the Guidelines

The recommended initial management of type 2 diabetes involves lifestyle modifications and metformin therapy, as metformin is the preferred initial pharmacologic agent for the treatment of type 2 diabetes, according to the most recent guidelines 1.

Key Components of Initial Management

• Lifestyle modifications, including dietary changes focusing on reduced caloric intake, portion control, and limiting refined carbohydrates while increasing fiber intake
• Regular physical activity of at least 150 minutes per week of moderate-intensity exercise
• Metformin therapy, starting at 500 mg once or twice daily with meals, gradually increasing to a target dose of 1000 mg twice daily as tolerated to minimize gastrointestinal side effects

Importance of Metformin

• Metformin improves insulin sensitivity and reduces hepatic glucose production without causing hypoglycemia or weight gain, making it an ideal first-line medication for type 2 diabetes 1
• Metformin may reduce risk for cardiovascular events and death, and is inexpensive, making it a cost-effective option for patients with type 2 diabetes 1

Monitoring and Follow-up

• Blood glucose monitoring is important, with target fasting glucose of 80-130 mg/dL and postprandial glucose below 180 mg/dL
• Regular HbA1c testing every 3-6 months helps track long-term control, with a general target below 7% 1

Patient-Centered Approach

• A patient-centered approach should be used to guide the choice of pharmacologic agents, considering comorbidities, hypoglycemia risk, impact on weight, cost, risk for side effects, and patient preferences 1

From the FDA Drug Label

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 initial management of type 2 diabetes includes:

• Diet: to help lower blood sugar levels
• Exercise: to improve insulin sensitivity and glucose uptake
• Medicines: when necessary, to help lower blood sugar levels It is essential to talk to your healthcare provider about how to prevent, recognize, and take care of low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), and problems you have because of your diabetes 2.

From the Research

Initial Management of Type 2 Diabetes

The initial management of type 2 diabetes involves a combination of lifestyle interventions and medication.

• Intensive lifestyle intervention, including at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet 3
• Aggressive management of cardiovascular risk factors, such as hypertension, dyslipidemia, and microalbuminuria, with the use of aspirin, statins, and angiotensin-converting enzyme inhibitors 3
• Normalization of blood glucose levels, with a hemoglobin A1C level less than 7 percent 3

Medication

• Metformin is considered a first-line agent for the treatment of type 2 diabetes, as it decreases hepatic glucose output and sensitizes peripheral tissues to insulin 3
• Other medications, such as sulfonylureas and nonsulfonylurea secretagogues, alpha glucosidase inhibitors, and thiazolidinediones, may also be used to improve glycemic control 3
• Pioglitazone, a thiazolidinedione, can be administered in combination with metformin, sulfonylureas, exenatide, dipeptidyl peptidase 4 (DPP-4) inhibitors, or insulin to improve glycemic control 4

Lifestyle Intervention

• Adherence to a healthy diet and regular physical activity are crucial for sufficient type 2 diabetes management 5
• A personalized diabetes management mHealth application can help patients and healthcare professionals monitor food intake, physical activity, glucose values, and medication use, and provide tailored coaching to improve adherence to lifestyle recommendations and medication use 5
• Lifestyle change is probably the most important single action to prevent type 2 diabetes mellitus, and a low-intensity individual lifestyle intervention by a physician can be effective in achieving lifestyle changes in persons at risk for type 2 diabetes 6

Combination Therapies

• Pioglitazone combination therapies, such as pioglitazone + metformin or pioglitazone + sulfonylurea, can improve glycemic control and other cardiovascular risk factors in non-insulin-treated type 2 diabetes patients who are failing previous hypoglycemic therapy 7
• These combination therapies can increase HDL-cholesterol and decrease triglycerides and the atherogenic index of plasma, and decrease the proportion of patients at high risk for microvascular and macrovascular events 7