From the Guidelines
Type 2 diabetes management should prioritize a patient-centered approach, focusing on lifestyle modifications and personalized medication therapy to control blood glucose levels, with a target hemoglobin A1C level between 7% and 8% for most patients, as recommended by the American College of Physicians 1.
Key Components of Management
- Lifestyle changes: balanced diet, regular physical activity (aim for 150 minutes weekly), weight management, and smoking cessation
- First-line medication therapy: metformin, starting at 500 mg once or twice daily and gradually increasing to 1000 mg twice daily as tolerated
- Second-line medication therapy: consider SGLT-2 inhibitors (like empagliflozin 10-25 mg daily or dapagliflozin 5-10 mg daily) or GLP-1 receptor agonists (like semaglutide 0.25-1 mg weekly) for patients with cardiovascular or kidney disease, as recommended by the American Diabetes Association and the European Association for the Study of Diabetes 1
- Regular monitoring: quarterly A1C testing until stable, annual kidney function tests, eye exams, and foot examinations
Personalized Approach
- Consider individualized glycemic and weight goals, as well as the presence of other metabolic comorbidities and the risk of hypoglycemia, when selecting subsequent glucose-lowering agents 1
- Use a person-centered shared decision-making approach to 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
Special Considerations
- For patients with heart failure, an SGLT2 inhibitor is recommended for glycemic management and prevention of heart failure hospitalizations 1
- For patients with limited life expectancy or multiple comorbid conditions, consider relaxing the target HbA1c level and focusing on minimizing symptoms rather than achieving a specific target, as recommended by the American College of Physicians 1
From the FDA Drug Label
The management of antidiabetic therapy should be individualized. Ideally, the response to therapy should be evaluated using HbA1c which is a better indicator of long-term glycemic control than FPG alone. In clinical use, it is recommended that patients be treated with ACTOS for a period of time adequate to evaluate change in HbA1c (three months) unless glycemic control deteriorates.
The guidelines for Type 2 Diabetes Mellitus (T2DM) management include:
- Individualized management of antidiabetic therapy
- Evaluation of response to therapy using HbA1c, which reflects glycemia over the past two to three months
- Treatment duration of at least three months to evaluate change in HbA1c, unless glycemic control deteriorates 2
- Adjunct to diet and exercise to improve glycemic control, as indicated for metformin 3 and pioglitazone 2
From the Research
Guidelines for Type 2 Diabetes Mellitus (T2DM) Management
- The management of T2DM involves lifestyle modifications, including diet and physical activity, as well as pharmacologic agents 4.
- Moderate to vigorous physical activity is recommended to manage T2D, with daily physical activity such as walking, gardening, and housework also being beneficial 5.
- Walking for at least 30 min per day has been shown to reduce the risk of T2D by approximately 50% 5.
- Professional health education can help modify urbanization-related lifestyle habits and is the foundation for self-management of type 2 diabetes 6.
- Guidelines on diabetes nutrition and physical activity encourage patients to self-manage their diabetes, with patients needing more professional knowledge to manage the disease through lifestyle modifications 6.
Lifestyle Changes for T2DM Prevention
- Lifestyle changes, including a healthy diet and increased physical activity, can prevent T2D, with a risk reduction of 0.53 (95% CI 0.41; 0.67) 7.
- A diet relatively low in saturated fat and high in fiber, such as the Mediterranean dietary pattern, can be recommended for the long-term prevention of diabetes 7.
- Weight reduction and increased physical activity are also important for T2D prevention 7.
Pharmacologic Agents for T2DM Management
- Dipeptidylpeptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are two classes of pharmacologic agents used to manage T2DM 8.
- DPP-4 inhibitors offer several advantages compared with GLP-1 receptor agonists, including easiness of use, tolerance profile, and cost 8.
- However, GLP-1 receptor agonists may be more potent in improving glucose control, promoting weight reduction, and reducing blood pressure compared to DPP-4 inhibitors 8.