From the Guidelines
The recommended treatment plan for a patient with type 2 diabetes includes lifestyle modifications and medication therapy, with metformin as the first-line medication, and SGLT-2 inhibitors or GLP-1 receptor agonists as second-line options for patients with established cardiovascular disease or at high risk of cardiorenal disease, as recommended by the most recent guidelines 1.
Key Components of Treatment
- Lifestyle modifications: weight loss through a balanced diet and regular exercise (150 minutes of moderate activity weekly) 1
- Medication therapy: metformin as the first-line medication, starting at 500mg daily and gradually increasing to 1000mg twice daily as tolerated 1
- Second-line options: SGLT-2 inhibitors (like empagliflozin 10-25mg daily) or GLP-1 receptor agonists (like semaglutide 0.25-1mg weekly) for patients with established cardiovascular disease or at high risk of cardiorenal disease 1
- Blood glucose monitoring: target HbA1c below 7% for most patients 1
- Regular screening for complications: annual eye exams, foot examinations, and kidney function tests 1
- Blood pressure control: maintain below 140/90 mmHg, and statins are often prescribed for cardiovascular protection 1
Considerations for Treatment
- Patient-centered approach: consider individualized glycemic and weight goals, as well as the presence of other metabolic comorbidities and the risk of hypoglycemia 1
- Early combination therapy: can be considered in adults with type 2 diabetes at treatment initiation to shorten time to attainment of individualized treatment goals 1
- Weight management: additional weight management interventions (e.g., intensification of lifestyle modifications, structured weight management programs, pharmacologic agents, or metabolic surgery, as appropriate) are recommended for adults with type 2 diabetes who have not achieved their individualized weight goals 1
From the FDA Drug Label
Combination Therapy Three 16-week, randomized, double-blind, placebo-controlled clinical studies and three 24-week, randomized, double-blind, dose-controlled clinical studies were conducted to evaluate the effects of ACTOS on glycemic control in patients with type 2 diabetes who were inadequately controlled (HbA1c ≥ 8%) despite current therapy with a sulfonylurea, metformin, or insulin For patients who had not been previously treated with antidiabetic medication (24%), mean values at screening were 10.1% for HbA1c and 238 mg/dL for FPG. At baseline, mean HbA1c was 10.2% and mean FPG was 243 mg/dL. Compared with placebo, treatment with ACTOS titrated to a final dose of 30 mg and 45 mg resulted in reductions from baseline in mean HbA1c of 2.3% and 2. 6% and mean FPG of 63 mg/dL and 95 mg/dL, respectively.
The recommended treatment plan for a patient with Diabetes Type 2 (DM2) may include monotherapy or combination therapy with medications such as pioglitazone (ACTOS), sulfonylurea, metformin, or insulin.
- Monotherapy: Pioglitazone (ACTOS) can be used as a single agent to improve glycemic control in patients with type 2 diabetes.
- Combination Therapy: Pioglitazone (ACTOS) can be used in combination with other antidiabetic agents such as sulfonylurea, metformin, or insulin to achieve better glycemic control. The treatment plan should be individualized based on the patient's specific needs and medical history. 2 2 2
From the Research
Treatment Plan for Diabetes Type 2
The recommended treatment plan for a patient with diabetes type 2 (DM2) involves a combination of lifestyle modifications and medications.
- Lifestyle modifications include:
- Diet: Although no specific diet has been proven to be most effective for improving health outcomes, weight management is an important component of treatment for type 2 diabetes 3.
- Physical activity: Physical activity can reduce hemoglobin A1C by 0.4% to 1.0% and improve cardiovascular risk factors 3.
- Weight management: Even moderate weight loss in combination with increased activity can improve insulin sensitivity and glycemic control in patients with type 2 diabetes 4.
- Medications:
- First-line medications: Metformin and, in patients with cardiovascular or kidney comorbidities or at high cardiovascular risk, glucagon-like peptide-1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is) 3.
- Add-on medications: Dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1RAs, dipeptidyl peptidase-4 inhibitors, sulfonylureas, and thiazolidinediones 3.
- Insulin therapy: Approximately one-third of patients with type 2 diabetes require treatment with insulin during their lifetime 3.
Benefits of Specific Medications
Several randomized clinical trials have demonstrated benefits of specific SGLT2i and GLP-1RA medications compared with placebo for:
- Atherosclerotic cardiovascular disease: 12%-26% risk reduction 3.
- Heart failure: 18%-25% risk reduction 3.
- Kidney disease: 24%-39% risk reduction 3. Additionally, SGLT2 inhibitors have been associated with a reduced risk of all-cause mortality compared with sulfonylureas 5.
Monitoring and Management
A personalized diabetes management application can help monitor diet, physical activity, and glucose values, and provide tailored coaching to improve adherence to lifestyle recommendations and medication use 6.
- Requirements for such an application include:
- Measuring food intake, physical activity, glucose values, and medication use.
- Integrating this data to provide patients and healthcare professionals with insight into these factors and the effect of lifestyle on glucose values in daily life.