From the Guidelines
Lifestyle management is crucial for newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients to prevent complications, and should include a balanced diet, regular physical activity, and weight loss of 5-10% of body weight for overweight patients, as recommended by the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD 1.
Key Recommendations
- Patients should adopt a Mediterranean diet supplemented with olive oil and/or nuts to reduce the incidence of major CV events, as shown in the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD 1.
- Regular physical activity should include at least 150 minutes of moderate-intensity exercise weekly, such as brisk walking, swimming, or cycling, spread across most days, as recommended by the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD 1.
- Weight loss of 5-10% of body weight is recommended for overweight patients, as stated in the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD 1.
- Blood glucose monitoring should be performed as directed by healthcare providers, typically before meals and at bedtime.
- Medication adherence is critical, with common first-line treatments including metformin, as recommended by the 2021 guideline recommendations and the positioning of newer drugs in type 2 diabetes care 1.
Additional Considerations
- Patients should quit smoking and limit alcohol consumption, as recommended by the 2016 American Diabetes Association standards of medical care in diabetes 1.
- Regular screening for complications is necessary, as T2DM can lead to serious issues including cardiovascular disease, nephropathy, retinopathy, neuropathy, and foot problems, as stated in the 2016 American Diabetes Association standards of medical care in diabetes 1.
- Stress management techniques and adequate sleep (7-8 hours nightly) also help maintain stable blood glucose levels and overall health, as recommended by the 2024 pharmacologic approaches to glycemic treatment: standards of care in diabetes-2024 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Lifestyle Management in Newly Diagnosed T2DM
- Lifestyle interventions remain the cornerstone of therapy for type 2 diabetes mellitus (T2DM) 2
- Most patients with T2DM will also require pharmacotherapy due to the progressive nature of the disease 2
Complications of T2DM
- T2DM is a complex disease that can lead to various complications, including heart failure (HF) 3
- The co-existence of T2DM and HF markedly increases an individual's morbidity and mortality 3
- Early diagnosis and treatment of HF in T2DM patients is crucial to prevent further complications 3
Treatment Options for T2DM
- Metformin is the first-line treatment for all T2DM patients, and sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the preferred drugs for patients with T2DM and HF 3
- Pioglitazone is a valuable component of combination therapy for T2DM, but it should be used with caution in patients with heart failure due to the risk of water retention 4
- The choice of initial oral hypoglycemic therapy in primary care settings is influenced by clinical and demographic characteristics, such as age, race, and HbA1c levels 5
Efficacy and Tolerability of Treatment Options
- Pioglitazone has been shown to be effective in improving glycemic control and reducing vascular risk, with a low incidence of hypoglycemia 6
- However, pioglitazone is associated with an increased risk of heart failure and fractures, and should be used with caution in patients with these conditions 6
- The efficacy and tolerability of pioglitazone compared to other oral antihyperglycaemic agents, such as metformin and sulfonylureas, have been studied, and pioglitazone has been found to have similar efficacy and a favorable safety profile 6