From the Guidelines
Diabetes management should prioritize lifestyle changes, including a Mediterranean diet and moderate-to-vigorous physical activity, alongside personalized medication plans to achieve optimal glycemic control and reduce cardiovascular risk. The most recent guidelines, such as those from the European Heart Journal 1, emphasize the importance of lifestyle modifications in preventing diabetes and its cardiovascular complications. Key recommendations include reduced calorie intake to lower excessive body weight, a Mediterranean diet supplemented with olive oil and/or nuts to reduce major cardiovascular events, and at least 150 minutes of moderate-to-vigorous physical activity per week for the prevention and control of diabetes.
Lifestyle Modifications
- A Mediterranean diet has been shown to reduce the incidence of major cardiovascular events 1.
- Moderate-to-vigorous physical activity of more than 150 minutes per week is recommended for the prevention and control of diabetes 1.
- Even modest weight loss can delay the progression from pre-diabetes to type 2 diabetes, with each additional kilogram lost associated with a 43% lower odds of type 2 diabetes 1.
Medication Plans
- First-line medication for type 2 diabetes is typically metformin, with considerations for SGLT-2 inhibitors or GLP-1 receptor agonists in patients with established cardiovascular disease or high risk 1.
- The choice of pharmacologic agents should be guided by a person-centered shared decision-making approach, considering factors such as cardiovascular and renal comorbidities, effectiveness, hypoglycemia risk, impact on weight, cost, and individual preferences 1.
- For adults with type 2 diabetes who have heart failure, an SGLT2 inhibitor is recommended for glycemic management and prevention of heart failure hospitalizations 1.
Monitoring and Screening
- Regular monitoring through self-glucose checks and quarterly HbA1c tests is essential to assess glycemic control 1.
- Screening for complications affecting the eyes, kidneys, feet, and cardiovascular system is crucial for early detection and management of diabetes-related complications.
Given the most recent and highest quality evidence, the focus should be on achieving and maintaining near-normoglycemia through a combination of lifestyle modifications and personalized medication plans, with regular monitoring and screening to prevent both acute and long-term complications 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. Glycosylated hemoglobin levels may also be of value in monitoring the patient's response to therapy. Periodic measurement of HbA1c is recommended for the monitoring of long-term glycemic control.
Diabetes Guidelines:
- The management of antidiabetic therapy should be individualized.
- HbA1c is a better indicator of long-term glycemic control than FPG alone.
- Patients should be treated for a period of time adequate to evaluate change in HbA1c (three months) unless glycemic control deteriorates.
- Glycosylated hemoglobin levels may also be of value in monitoring the patient's response to therapy.
- Periodic measurement of HbA1c is recommended for the monitoring of long-term glycemic control 2, 3, 4.
From the Research
Diabetes Guidelines
- The management of type 2 diabetes mellitus can be achieved through various treatment options, including sitagliptin, a dipeptidyl peptidase-4 inhibitor, which has been shown to improve glycaemic control in patients with type 2 diabetes 5.
- Lifestyle interventions, such as diet and physical activity, have been found to be effective in achieving diabetes remission, reducing weight, and improving quality of life in patients with type 2 diabetes mellitus 6.
- The addition of pioglitazone or sitagliptin to metformin and a sulfonylurea has been shown to be effective in improving glycemic control in patients with type 2 diabetes inadequately controlled on metformin and a sulfonylurea 7.
- Primary prevention of diabetes can be achieved through moderate diet and lifestyle modifications, including maintaining a healthy body weight, increasing physical activity, and reducing sedentary behaviors 8.
- A systematic review and meta-analysis found that lifestyle changes, including a healthy diet and regular physical activity, can prevent type 2 diabetes, with a sustained risk reduction for many years after the active intervention 9.
Treatment Options
- Sitagliptin has been shown to be a useful treatment option for patients with type 2 diabetes, with potential advantages including oral administration, a generally weight-neutral effect, and a low risk of hypoglycaemia 5.
- Pioglitazone and sitagliptin have been found to achieve similar improvements in overall glycemic control in patients with type 2 diabetes inadequately controlled with metformin and a sulfonylurea, although there were some differences in terms of fasting plasma glucose, high-sensitive C-reactive protein, lipids, body-weight change, and adverse events 7.
Lifestyle Interventions
- Diet and physical activity have been found to have a significant effect on blood glucose and weight control in patients with type 2 diabetes mellitus 6.
- A healthy diet, together with regular physical activity, maintenance of a healthy weight, moderate alcohol consumption, and avoidance of sedentary behaviors and smoking, could nearly eliminate type 2 diabetes 8.
- The Mediterranean dietary pattern has been recommended for the long-term prevention of diabetes, based on the results of the PREDIMED trial 9.