What are the treatment options for Diabetes Mellitus (DM)?

From the Guidelines

Diabetes treatment involves a combination of lifestyle changes, medication, and regular monitoring, with the primary goal of maintaining blood glucose within healthy ranges and preventing complications, as recommended by the American Diabetes Association standards of medical care in diabetes 1.

Lifestyle Modifications

For type 2 diabetes, start with lifestyle modifications including:

• A balanced diet low in refined carbohydrates
• Regular exercise, aiming for at least 150 minutes of moderate-intensity aerobic activity per week
• Weight management, with a goal of losing at least 5% of body weight

Medications

Medications typically begin with metformin (starting at 500mg once or twice daily, increasing to 1000mg twice daily as tolerated) as first-line therapy, due to its efficacy, safety, and potential to reduce the risk of cardiovascular events and death 1. If blood glucose remains uncontrolled, additional medications may be added, such as:

• SGLT-2 inhibitors (e.g., empagliflozin, dapagliflozin)
• GLP-1 receptor agonists (e.g., semaglutide, dulaglutide)
• DPP-4 inhibitors (e.g., sitagliptin)
• Sulfonylureas (e.g., glipizide)

Insulin Therapy

For type 1 diabetes, insulin therapy is essential, typically using a combination of:

• Basal insulin (e.g., glargine or detemir)
• Mealtime insulin (e.g., lispro or aspart)

Monitoring

Blood glucose monitoring is crucial, with target fasting levels of 80-130 mg/dL and post-meal levels below 180 mg/dL. Regular A1C testing (aiming for below 7% for most adults) helps track long-term control.

Patient-Centered Approach

A patient-centered approach should guide the choice of pharmacologic agents, considering factors such as efficacy, cost, potential side effects, and patient preferences 1.

The most effective treatment plan will depend on individual patient needs and circumstances, and should be tailored to achieve optimal glycemic control while minimizing the risk of hypoglycemia and other complications, as supported by the American Diabetes Association standards of medical care in diabetes 1.

From the FDA Drug Label

In a randomized, controlled clinical study (Study E) in 570 adults with type 2 diabetes, Insulin Glargine was evaluated for 52 weeks in combination with oral antidiabetic medications (a sulfonylurea, metformin, acarbose, or combinations of these drugs). In a randomized, controlled clinical study (Study F), in adult patients with type 2 diabetes not using oral antidiabetic medications (n=518), a basal-bolus regimen of Insulin Glargine once daily at bedtime or NPH insulin administered once or twice daily was evaluated for 28 weeks. The safety and efficacy of once daily Insulin Glargine administered either at pre-breakfast, pre-dinner, or at bedtime were evaluated in a randomized, controlled clinical study in adult patients with type 1 diabetes (Study H, n=378) The safety and efficacy of once daily Insulin Glargine administered pre-breakfast or at bedtime were also evaluated in a randomized, active-controlled clinical study (Study I, n=697) in patients with type 2 diabetes not adequately controlled on oral antidiabetic therapy.

The treatment options for Diabetes Mellitus (DM) include:

• Insulin Glargine administered once daily at bedtime, in combination with oral antidiabetic medications or as part of a basal-bolus regimen 2
• NPH insulin administered once or twice daily, in combination with oral antidiabetic medications or as part of a basal-bolus regimen 2
• Basal-bolus regimen with Insulin Glargine or NPH insulin, and regular human insulin or insulin lispro before meals 2
• Oral antidiabetic medications, such as sulfonylurea, metformin, or acarbose, in combination with Insulin Glargine or NPH insulin 2

From the Research

Treatment Options for Diabetes Mellitus (DM)

The treatment options for Diabetes Mellitus (DM) include:

• Insulin therapy, which is the primary treatment for type 1 diabetes mellitus (T1DM) 3, 4, 5, 6
• Oral antidiabetic medications, which may be used in combination with insulin therapy for type 2 diabetes mellitus (T2DM) 3, 7
• Lifestyle modifications, such as diet and physical activity, which are important for managing both T1DM and T2DM 3, 6

Insulin Therapy

Insulin therapy can be administered through:

• Multiple daily injections of basal and bolus insulin 3, 4, 5, 6
• Continuous subcutaneous insulin infusion (CSII) 4, 6
• Premixed insulin preparations 3, 4 Insulin analogs, such as rapid-acting and long-acting insulins, can be used to improve glycemic control and reduce hypoglycemia risk 3, 4, 5, 6, 7

Glycemic Targets

The target glycated hemoglobin A1c (HbA1c) levels for patients with DM are:

• < 7.5% (< 58 mmol/mol) for children with T1DM 3
• < 7% (53 mmol/mol) for nonpregnant adults with T1DM 6
• ≥ 7.5% (≥ 58 mmol/mol) for patients with T2DM who require insulin therapy 3

Blood Glucose Monitoring

Blood glucose monitoring is an essential part of effective insulin therapy, and can be used to:

• Titrate basal insulin doses based on fasting plasma glucose (FPG) values 3
• Titrate mealtime insulin doses based on FPG and postprandial glucose (PPG) values 3
• Monitor glycemic control and adjust treatment regimens as needed 3, 6