From the Guidelines
Type 2 diabetes mellitus (T2DM) can lead to numerous serious complications affecting multiple body systems, and tight glycemic control, blood pressure management, lipid control, regular screening, and lifestyle modifications are essential to prevent these complications and reduce morbidity and mortality. The major complications of T2DM include macrovascular problems such as coronary artery disease, stroke, and peripheral arterial disease, which occur due to accelerated atherosclerosis 1. Microvascular complications include diabetic nephropathy (kidney damage that can progress to end-stage renal disease), diabetic retinopathy (which can cause blindness), and diabetic neuropathy (nerve damage leading to pain, numbness, or autonomic dysfunction) 1. Other significant complications include diabetic foot ulcers (which may lead to amputations), increased susceptibility to infections, skin conditions, hearing impairment, and cognitive decline 1.
These complications develop primarily due to chronic hyperglycemia, which causes oxidative stress, inflammation, and advanced glycation end-products formation. Additionally, insulin resistance and associated metabolic abnormalities like hypertension and dyslipidemia contribute to organ damage. The American Diabetes Association recommends a target HbA1c <7% for most adult patients, and optimal management of T2D is achieved with a multidimensional approach that includes medical nutritional therapy, lifestyle counseling, diabetes self-management, education, and support, and medication therapy 1.
Some key points to consider in the management of T2DM include:
- Tight glycemic control (maintaining HbA1c below 7%) to reduce the risk of microvascular complications 1
- Blood pressure management (target <140/90 mmHg) to reduce the risk of cardiovascular disease 1
- Lipid control to reduce the risk of cardiovascular disease 1
- Regular screening for complications, including eye exams, foot examinations, kidney function tests, and cardiovascular assessments 1
- Lifestyle modifications, including medical nutritional therapy, lifestyle counseling, and diabetes self-management, education, and support 1
Overall, a comprehensive approach to the management of T2DM is necessary to prevent complications and reduce morbidity and mortality. Early detection and timely intervention are critical to reducing the risk of complications and improving outcomes in patients with T2DM.
From the Research
Complications of T2DM
- The treatment of type 2 diabetes mellitus (T2DM) requires a multifaceted approach, including lifestyle modification and pharmacological therapy, to address glycemia and cardiovascular disease 2.
- Patients with T2DM often require treatments to address additional cardiovascular risk factors, such as hypertension and dyslipidemia, in addition to agents that improve hyperglycemia 2.
- Several factors contribute to the failure to meet treatment goals, including poor adherence by patients to lifestyle and pharmacological treatment, lack of understanding by patients of the long-term benefits of treatment, and failure of health care providers to initiate or intensify medications appropriately 2.
Cardiovascular Complications
- T2DM is associated with an increased risk of cardiovascular disease, and the management of cardiovascular risk factors is an important aspect of T2DM treatment 2, 3.
- The American Association of Clinical Endocrinologists/American College of Clinical Endocrinology T2DM management algorithm recommends initial dual agent combination therapy when a single agent is unlikely to achieve target glycemia, particularly for patients with atherosclerotic cardiovascular disease 4.
- Recent cardiovascular outcome trial results have demonstrated the CV safety and efficacy of certain antihyperglycemic medications, and the treatment algorithm for patients with T2DM and atherosclerotic vascular disease may need to be revised 3.
Treatment Options
- Metformin is the initial pharmacologic choice for most patients with T2DM, but the selection of another antihyperglycemic agent will depend on the presence of atherosclerotic cardiovascular disease and other patient-specific factors 4, 5.
- Combination therapy may be administered as a multi-pill regimen, a single-pill combination, or as a combination of oral and/or injectable therapies 4.
- Newer pharmacologic treatments for T2DM, such as glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, are efficacious and exhibit positive effects on weight, with minimal risk of hypoglycemia 6.