What is the treatment for Diabetes Mellitus (DM) type 2?

From the Guidelines

The treatment of Type 2 Diabetes Mellitus (DM II) should begin with lifestyle modifications and metformin as first-line therapy, with a focus on minimizing morbidity, mortality, and improving quality of life. Patients should aim for weight loss through dietary changes (reduced calorie intake, limiting refined carbohydrates) and regular physical activity (150 minutes weekly of moderate exercise) 1. Metformin is usually started at 500mg once or twice daily with meals, gradually increasing to 1000mg twice daily as tolerated to minimize gastrointestinal side effects. If metformin alone is insufficient to reach target HbA1c levels (typically <7%), additional medications are added based on patient-specific factors, considering the evidence of benefits, harms, patient burden, and cost of medications, as well as patient preferences, glycemic control target, comorbid conditions, and risk for symptomatic hypoglycemia 1.

Some key points to consider in the treatment of Type 2 Diabetes include:

• Early combination therapy can be considered to shorten the time to attainment of individualized treatment goals 1
• Selection of subsequent glucose-lowering agents should take into consideration the individualized glycemic and weight goals, as well as the presence of other metabolic comorbidities and the risk of hypoglycemia 1
• A person-centered shared decision-making approach should guide the choice of pharmacologic agents, considering the effects on cardiovascular and renal comorbidities, effectiveness, hypoglycemia risk, impact on weight, cost and access, risk for adverse reactions and tolerability, and individual preferences 1
• SGLT-2 inhibitors and GLP-1 agonists are often preferred second-line agents due to their cardiovascular benefits and weight loss effects 1

Regular blood glucose monitoring, quarterly HbA1c testing, and annual screenings for complications (eye exams, kidney function tests, foot examinations) are essential components of comprehensive diabetes management, aiming to reduce morbidity, mortality, and improve quality of life 1. This multi-faceted approach addresses the underlying insulin resistance and relative insulin deficiency that characterize Type 2 diabetes. The most recent and highest quality study recommends metformin as the preferred initial pharmacologic agent, with subsequent therapy individualized based on patient-specific factors 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 treatment for Diabetes Mellitus (DM) type 2 includes:

• Diet: to lower blood sugar
• Exercise: to lower blood sugar
• Medicines: such as metformin 2 and pioglitazone 3, 3 when necessary, to lower blood sugar. Key points to consider:
• The goal of treatment is to lower blood sugar to a normal level
• Treatment may involve a combination of diet, exercise, and medication
• Medications such as metformin and pioglitazone can be used to lower blood sugar, and may be used in combination with other medications, such as sulfonylurea or insulin.

From the Research

Treatment Options for Type 2 Diabetes Mellitus

The treatment for Type 2 Diabetes Mellitus (DM) includes:

• Diet and exercise
• Oral antihyperglycemic agents, such as metformin 4, 5, 6, 7
• Insulin therapy, which can be used in combination with metformin 5
• Other medications, such as sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors 6
• Pioglitazone, a thiazolidinedione that can be used in combination with metformin, sulfonylureas, or insulin 8

First-Line Treatment

Metformin is often recommended as the first-line treatment for Type 2 Diabetes Mellitus due to its effectiveness in improving glycemic control and its relatively low risk of hypoglycemia and weight gain 4, 6, 7.

Combination Therapy

Combination therapy, such as metformin plus sulfonylurea or insulin, can be effective in achieving glycemic control in patients who do not respond to monotherapy 4, 5. Combination therapy with pioglitazone and other medications, such as metformin or sulfonylureas, can also be effective in improving glycemic control and reducing the risk of cardiovascular complications 8.

Considerations for Treatment

When selecting a treatment for Type 2 Diabetes Mellitus, considerations should include the patient's individual characteristics, such as the presence of cardiovascular disease or kidney disease, as well as the potential side effects and interactions of the medication 6. Medications that have cardiovascular or renal benefits, such as SGLT2 inhibitors and GLP1 receptor agonists, should be prescribed for patients with these comorbidities 6.