What is the management of hyperglycemia?

From the Guidelines

Management of Hyperglycemia

Hyperglycemia control can be achieved through a multifaceted approach, including lifestyle modifications and pharmacological interventions. For patients with type 2 diabetes, initial treatment with metformin 500-1000 mg orally twice daily is recommended, with dose titration as needed to achieve a hemoglobin A1c (HbA1c) level less than 7% 1.

Key Considerations

• Lifestyle modifications are fundamental in managing hyperglycemia, including medical nutrition therapy, physical activity, weight loss, counseling for smoking cessation, and psychological support 1.
• Pharmacological interventions should be individualized based on patient preferences, risk of adverse effects, and patient characteristics, including frailty and comorbid conditions 1.
• Adjunctive therapy with sulfonylureas, such as glipizide 5-10 mg orally daily, or dipeptidyl peptidase-4 inhibitors, such as sitagliptin 100 mg orally daily, may be considered for patients who do not achieve adequate glycemic control with metformin alone 1.

Glycemic Targets

• A reasonable HbA1c target for most nonpregnant adults with sufficient life expectancy to see microvascular benefits is around 53 mmol/mol (7%) or less 1.
• Glycemic treatment targets should be individualized based on patient preferences and goals, risk of adverse effects of therapy, and patient characteristics, including frailty and comorbid conditions 1.

Hypoglycemia Management

• Hypoglycemia (plasma glucose level <3.9 mmol/L [<70 mg/dL]) is a major limiting factor in the glycemic management of type 1 and type 2 diabetes 1.
• Patients at risk for severe hypoglycemia should be prescribed glucagon, and their close contacts should be instructed on how to administer it 1.

From the FDA Drug Label

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. Talk to your healthcare provider about how to prevent, recognize, and take care of low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), and problems you have because of your diabetes.

The management of hyperglycemia involves:

• Diet: Caloric restriction and weight loss are essential in the obese diabetic patient.
• Exercise: Regular physical activity should be stressed.
• Medicines: Certain medicines, such as metformin or glipizide, may be necessary to lower blood sugar to a normal level. It is essential to work with a healthcare provider to develop a personalized plan for managing hyperglycemia, as the best approach may vary depending on individual circumstances 2, 2, 3.

From the Research

Management of Hyperglycemia

The management of hyperglycemia in patients with type 2 diabetes mellitus (T2DM) involves a combination of lifestyle modifications and pharmacological interventions.

• Lifestyle modifications include a healthy, plant-based diet that is low in saturated fat and refined carbohydrates but high in whole grains, vegetables, legumes, and fruits, coupled with resistance and aerobic exercise regimens 4.
• Pharmacological interventions may involve the use of metformin, sulfonylurea, or insulin as monotherapy or in combination 5, 4, 6.
• The choice of therapy depends on various factors, including the patient's age, body mass index, and glycemic control, as well as the presence of any comorbidities 5, 4.

Treatment Strategies

Several treatment strategies have been proposed for managing hyperglycemia in patients with T2DM, including:

• The metformin, glucagon-like peptide-1 receptor agonist, and insulin (MGI) approach, which involves the use of metformin as first-line therapy, followed by the addition of glucagon-like peptide-1 receptor agonists and insulin as needed 4.
• The use of rapid-acting insulin analogs, premixed insulin, and glucagon-like peptide-1 receptor agonists to control postprandial glucose levels 6, 7.
• A personalized multi-interventional approach that focuses on customized nutrition, progressive fitness, and lifestyle modification, which has been shown to be effective in reducing HbA1c, fasting blood sugar, and weight in patients with T2DM 8.

Goals of Therapy

The goals of therapy for hyperglycemia in patients with T2DM include:

• Achieving target levels of glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) 5, 4.
• Controlling postprandial glucose levels to reduce the risk of cardiovascular complications 6, 7.
• Minimizing the risk of hypoglycemia and other adverse events associated with therapy 4, 6.