From the Guidelines
Type 2 diabetes mellitus (T2DM) treatment should start with lifestyle modifications, including dietary changes and regular exercise, and metformin as the first-line medication, due to its effectiveness and safety profile, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment of T2DM involves a comprehensive approach that combines lifestyle modifications and medications.
- Dietary changes should focus on reduced carbohydrate intake, portion control, and increased fiber consumption.
- Regular exercise, such as 150 minutes of moderate-intensity aerobic activity per week, is also essential.
- Metformin is typically the first-line medication, starting at 500mg daily and increasing to 1000mg twice daily as tolerated, due to its effectiveness and safety profile, as well as its potential to reduce the risk of cardiovascular events and death 1.
Medication Management
If glycemic targets are not met with metformin alone, additional medications may be added, including:
- Sulfonylureas (glipizide, glyburide)
- DPP-4 inhibitors (sitagliptin)
- SGLT-2 inhibitors (empagliflozin, dapagliflozin)
- GLP-1 receptor agonists (semaglutide, dulaglutide)
- Insulin therapy The choice of pharmacologic agents should be guided by a person-centered shared decision-making approach, considering factors such as effectiveness, hypoglycemia risk, impact on weight, cost and access, and individual preferences 1.
Monitoring and Screening
Blood glucose monitoring is essential, with a target HbA1c below 7% for most patients. Regular screening for complications affecting the eyes, kidneys, feet, and cardiovascular system is also crucial. Treatment should be individualized based on patient characteristics, comorbidities, and preferences, and adjusted as needed to incorporate specific factors that impact choice of treatment 1.
From the FDA Drug Label
In adult patients with type 2 diabetes mellitus, treatment with JARDIANCE reduced hemoglobin A1c (HbA1c), compared to placebo. JARDIANCE has been studied as monotherapy and in combination with metformin, sulfonylurea, pioglitazone, linagliptin, and insulin. Treatment with JARDIANCE 10 mg or 25 mg daily provided statistically significant reductions in HbA1c, FPG, and body weight compared with placebo.
The treatment for Type 2 Diabetes Mellitus (Type 2 DM) includes:
- Monotherapy with JARDIANCE (empagliflozin)
- Combination therapy with JARDIANCE and other medications such as:
From the Research
Treatment Options for Type 2 Diabetes Mellitus
The treatment for Type 2 Diabetes Mellitus (Type 2 DM) typically involves a combination of lifestyle modifications and antidiabetic medications. The primary goals of treatment are to achieve effective control of blood glucose, blood pressure, and lipids, and to prevent complications associated with the disease 3.
Lifestyle Modifications
Lifestyle intervention strategies, including a healthy diet and regular exercise, are essential for managing Type 2 DM. A plant-based diet that is low in saturated fat and refined carbohydrates but high in whole grains, vegetables, legumes, and fruits is recommended, coupled with resistance and aerobic exercise regimens 4.
Antidiabetic Medications
Several antidiabetic medications are available for the treatment of Type 2 DM, including:
- Metformin, which is often the first-line treatment for Type 2 DM 4, 5
- Glucagon-like peptide-1 receptor agonists, which have weight loss potential and can target multiple pathophysiologic defects in patients with Type 2 DM 4, 3, 6
- Dipeptidyl peptidase-4 inhibitors, which improve glycemic control with similar efficacy to sulphonylureas but do not usually provoke hypoglycemia or weight gain 5, 3, 6
- Insulin, which may be necessary for patients who do not achieve glycemic control with oral medications 4, 7
Treatment Approach
A patient-centered treatment approach that addresses the core pathologies of Type 2 DM and obesity is recommended. This approach should emphasize weight management, limit the risk of hypoglycemia and adverse events, and focus on the individual patient's needs and characteristics 4, 5, 6. The choice of treatment should be based on the patient's specific needs and circumstances, and may involve a combination of lifestyle modifications and antidiabetic medications.
Key Considerations
When selecting a treatment for Type 2 DM, several key considerations should be taken into account, including: