From the Guidelines
Type 2 diabetes treatment should start with lifestyle modifications and metformin as the first-line medication, with additional medications added as needed to achieve glycemic control. The treatment approach should be individualized, considering patient preferences, disease characteristics, and potential side effects 1.
Initial Therapy
Initial therapy for type 2 diabetes should include lifestyle modifications, such as physical activity and weight loss, aiming for at least 5% of body weight loss 1. Metformin is the preferred initial pharmacologic agent, due to its efficacy, safety, and potential to reduce cardiovascular events and death 1. The initial dose of metformin should be 500mg once daily with meals, gradually increasing to 1000mg twice daily as tolerated.
Combination Therapy
When monotherapy with metformin is not sufficient to achieve glycemic control, a second agent should be added, considering the patient's characteristics, disease, and potential side effects 1. The choice of the second agent can be based on the patient's needs and preferences, and may include sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide-1 agonists, or basal insulin 1.
Key Considerations
Key considerations in the treatment of type 2 diabetes include:
- Individualizing glycemic targets and glucose-lowering therapies 1
- Considering patient preferences, needs, and values in treatment decisions 1
- Minimizing side effects and costs 1
- Regular blood glucose monitoring to achieve optimal glycemic control 1
- Comprehensive cardiovascular risk reduction as a major focus of therapy 1
Treatment Options
Treatment options for type 2 diabetes include:
- Metformin as the first-line medication
- Additional medications such as SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, or sulfonylureas
- Insulin therapy as a last resort or in cases of severe hyperglycemia
- Lifestyle modifications, including dietary changes and regular physical activity, as the foundation of any treatment program 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 options for Type 2 Diabetes Mellitus (T2DM) include:
- Diet
- Exercise
- Medicines when necessary, such as metformin hydrochloride tablets 2 2 It is recommended 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.
From the Research
Treatment Options for Type 2 Diabetes Mellitus (T2DM)
The treatment options for T2DM include:
- Medications such as metformin, sulfonylureas, thiazolidinediones, GLP-1 receptor agonists, DPP-4 inhibitors, and sodium-glucose co-transporter 2 inhibitors 3, 4, 5, 6
- Lifestyle interventions, including weight loss, regular physical activity, and a healthy eating pattern 7
- Insulin therapy for patients with symptoms of insulin deficiency 4
Medication-Based Treatments
Medications used to treat T2DM work through various mechanisms, including:
- Stimulating insulin secretion (sulfonylureas) 4, 5
- Increasing the concentration of endogenous active GLP-1 (DPP-4 inhibitors) 3, 6
- Activating GLP-1 receptors (GLP-1 receptor agonists) 3, 6
- Improving insulin sensitivity (thiazolidinediones) 5
- Reducing glucose reabsorption in the kidneys (sodium-glucose co-transporter 2 inhibitors) 4
Lifestyle Interventions
Lifestyle interventions, such as weight loss and regular physical activity, can also improve glycemic control in patients with T2DM 7. A weight loss of >5% is necessary for beneficial effects on HbA1c, lipids, and blood pressure 7.
Combination Therapies
Combination therapies, such as combining metformin with GLP-1 receptor agonists or sulfonylureas, can be effective in achieving glycemic control 3, 4, 5, 6. The choice of treatment should be individualized based on the patient's characteristics and the mechanism of action of each drug 4.