What are the best practices for Diabetes Mellitus (DM) management?

From the Guidelines

Diabetes management should prioritize a comprehensive approach combining medication, lifestyle changes, and regular monitoring, with metformin as the first-line treatment for type 2 diabetes, alongside lifestyle modifications, as recommended by the most recent guidelines 1.

Key Components of Diabetes Management

• Medication: Metformin is the preferred initial pharmacologic agent for type 2 diabetes, due to its efficacy, safety, and potential to reduce the risk of cardiovascular events and death 1.
• Lifestyle Changes:
  • Diet: A balanced diet limiting refined carbohydrates, with an emphasis on whole grains, fruits, vegetables, and lean proteins, is recommended for all individuals with diabetes 1.
  • Physical Activity: At least 150 minutes of moderate-intensity aerobic activity per week, reduced sedentary time, and resistance training at least twice per week for most adults with diabetes 1.
  • Weight Management: For overweight or obese adults with type 2 diabetes, reducing energy intake while maintaining a healthful eating pattern is recommended to promote weight loss 1.

Monitoring and Adjustments

• Blood Glucose Monitoring: Essential for managing diabetes, with targets generally being 80-130 mg/dL before meals and under 180 mg/dL after meals 1.
• Regular Medical Check-ups: Including HbA1c testing every 3-6 months to assess glycemic control and adjust treatment plans as needed 1.

Considerations for Type 1 and Advanced Type 2 Diabetes

• Insulin Therapy: Necessary for type 1 diabetes and advanced type 2 diabetes, with regimens including basal insulin and mealtime insulin, dosed by carbohydrate intake 1.
• Continuous Glucose Monitoring Systems: May be beneficial for reducing severe hypoglycemia risk in patients with type 1 diabetes 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. 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.

Diabetes Management: The goal of diabetes management is to lower blood sugar to a normal level through a combination of diet, exercise, and medication. The management of antidiabetic therapy should be individualized, and the response to therapy should be evaluated using HbA1c.

• Key considerations:
  • HbA1c is a better indicator of long-term glycemic control than FPG alone.
  • Diet and exercise can help lower high blood sugar.
  • Medication may be necessary to achieve normal blood sugar levels.
  • Individualized therapy is essential for effective diabetes management. 2 3

From the Research

Diabetes Management Strategies

• Lifestyle modifications, such as nutrition therapy and physical activity, can assist persons with diabetes to achieve metabolic goals 4
• Monitoring metabolic parameters, including blood glucose, glycated hemoglobin, lipids, blood pressure, and body weight, is essential to determine whether treatment goals are being achieved by lifestyle changes 4
• Evidence-based lifestyle habits, such as consuming low-carbohydrate, balanced meals and eating most carbohydrates early in the day, can improve diabetes management 5
• Postmeal glucose surges can be blunted without precipitating hypoglycemia with moderate exercise 30-60 minutes before the anticipated peak 5

Medication Therapies

• Sulfonylureas are potent glucose lowering drugs and are still the most frequently used second-line treatment for type 2 diabetes in many parts of the world 6
• The risk of hypoglycemia varies with different drugs within the sulfonylurea class and can be minimized by using the safer drugs, possibly in lower doses 6
• Pioglitazone, a thiazolidinedione, can be effective as an add-on medication to metformin or sulfonylurea in reducing post-load serum glucose levels 7
• Combination therapy with pioglitazone added to existing failing sulfonylurea therapy can result in decreases in glucose excursions after an oral glucose load without increasing post-load serum insulin concentrations 7

Patient-Centered Care

• Techniques to assess and facilitate adherence to lifestyle changes can be practical in primary care, including assessing patients' readiness to work toward change and addressing patients' conviction and confidence 8
• Long-term goals are best separated into highly specific short-term outcome goals and achievable behavior targets, and lifestyle goals and targets should be tailored to patients' preferences and progress 8
• Screening for diabetes-related attitudes, expectations, and quality of life, and addressing psychosocial factors, can facilitate the likelihood of success in diabetes management 8