Initial management of blood glucose in adults with type 2 diabetes mellitus free download as pdf file. Initial management of glycemia in type 2 diabetes nejm. Review of blood glucose logs must be part of any diabetes management plan. Correspondence from the new england journal of medicine initial management of glycemia in type 2 diabetes. Whereas there is consensus on the need for insulin, controversy exists on how to initiate and. The authors continue to endorse the principles used to develop the algorithm and its major features. The american diabetes association and the european association for the study of diabetes provides a guide for doctors in choosing the most appropriate interventions for patients with type 2 diabetes. The doctor should work closely with the nurse and other members of the diabetes health care team, whenever available, and with the person with diabetes. In patients diagnosed with diabetes mellitus dm, the therapeutic focus is on preventing complications caused by hyperglycemia. All patients with type 1 diabetes should participate in diabetes self management education and develop individualized premeal insulin bolus plans under the guidance of a. Idf clinical practice recommendations for managing type 2 diabetes. Initial management of severe hyperglycemia in type 2 diabetes. The goals of treatment for type 2 diabetes are to prevent.
How to use adas type 2 diabetes treatment algorithm carlos mendez, md, facp presenter disclosure information in compliance with the accrediting board policies, the. Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. Treatment should target multiple defects in t2dm and follow a patientcentered approach that considers factors beyond glycemic control, including cardiovascular risk reduction. Verify the role of initial combination therapy in patients. Comorbidity and glycemia control among patients with type 2 diabetes in primary care. An asymptomatic 45yearold hispanic man has a fasting plasma glucose level of 142 mg per deciliter 7.
Glp1 receptor agonists are generally recommended as the first injectable medication. Clinical presentation, diagnosis, and initial evaluation. Treatment of patients with type 2 diabetes mellitus includes education, evaluation for micro and macrovascular complications, attempts to. Type 2 dm typically has two pathophysiologic defects. Diabetes mellitus, type 2 drug therapy drug therapy, combination. Traveling down the long road to type 1 diabetes mellitus prevention. Prospective diabetes study ukpds suggest that early insulin treatment also lowers macrovascular risk in type 2 diabetes 3. Results from the efficacy and durability of initial combination therapy for type 2 diabetes edict. Management of persistent hyperglycemia in type 2 diabetes. Drug classes used for the treatment of type 2 diabetes include the following. Pharmacologic management of type 2 diabetes mellitus. This would allow for early implementation of therapeutic measures to control hyperglycemia, resulting in a hopefully costeffective intervention to reduce the. Patients with newly diagnosed type 2 diabetes mellitus t2dm can present to acute care sites with severe hyperglycemia defined as blood glucose bg greater than 300350 mgdl without diabetic ketoacidosis or hyperosmolar hyperglycemia. Intensive glycemic management resulting in lower a1c levels has also been shown to have a beneficial effect on cardiovascular disease cvd complications in type 1 diabetes 9,10.
He feels well except for 2 episodes of hypoglycemia in the last month. Type 2 diabetes mellitus formerly called noninsulin. Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Fasting blood glucose identify people with undiagnosed t2d and. He was found to have microalbuminuria 4 years ago, presumed secondary to diabetes. Association between type 2 diabetes mellitus, especially.
Management of glycemia in patients with diabetes mellitus. Type 2 diabetes mellitus dm is a common disease affecting 26 million people, 8. Lifestyle changes should be recommended at the time of diagno. A patientcentered approach position statement of the american diabetes association ada and the european association for the study of diabetes easd.
Monotherapy with metformin is indicated for most patients, and. Of these, an estimated 7 million people are undiagnosed. Management of blood glucose in type 2 diabetes mellitus aafp. These include additional focus on lifestyle management and diabetes self management education and support. How to use adas type 2 diabetes treatment algorithm. Initial management of glycemia in type 2 diabetes mellitus. Pdf comorbidity and glycemia control among patients with. Diabetes mellitus dm is a growing epidemic in the united states20. Clinical practice from the new england journal of medicine initial management of glycemia in type 2 diabetes mellitus. Glycemia intensify weight loss therapies td glp1ra progression overt diabetes. Previous studies have shown that acute correction of hyperglycemia in subjects with longstanding type 2 diabetes gives only shortterm improvement in glycemic control after discontinuation of insulin. The purpose of this study was to investigate the relationship between type 2 diabetes mellitus, especially uncontrolled glycemia, and intracranial plaque characteristics using. Undiagnosed type 2 diabetes mellitus t2dm is rare in the ado. Diabetes mellitus is associated with longterm complications, including retinopathy, nephropathy, and neuropathy.
Type 2 diabetes mellitus is a chronic, progressive dis ease characterized by multiple defects in glucose metabo lism, the core of which is insulin resistance in muscle, liver. Early initiation of pharmacologic therapy is associated with improved glycemic. Initial management of blood glucose in adults with type 2. In patients with type 1 dm, the starting dose is 15. Choices for the treatment of type 2 diabetes mellitus t2dm have multiplied as our understanding of the underlying pathophysiologic defects has evolved. Initial management of glycemia in type 2 diabetes mellitus d. Hyperglycemia may aggravate these defects, a feature known as glucose toxicity. Management of glycemia in type 2 diabetes sciencedirect. Combination of saxagliptin and metformin is effective as. Initial management of blood glucose in adults with type 2 diabetes mellitus. The consensus algorithm for the medical management of type 2 diabetes was published in august 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. He progressed to stage 2 chronic kidney disease ckd 2 years ago. Kaplanmeier plots of aggregate endpoints of microvascular disease in patients with type 2 diabetes mellitus in the united kingdom prospective diabetes study who were randomly assigned to receive either intensive therapy with a sulfonylurea or insulin, or to conventional treatment with diet. The management of type 2 diabetes has been revolutionized over the last 3 to 5 years as a result of dramatic changes in our health care system, new clinical trial data, novel pharmacologic agents, and a better understanding of appropriate methods for patient education regarding lifestyle issues.
Management of glycemia in patients with diabetes mellitus and ckd article in american journal of kidney diseases 505. All of these treatments need to be tempered based on. Initial treatment of patients with type 2 diabetes mellitus includes lifestyle changes focusing on diet, increased physical activity and exercise, and weight reduction, reinforced by consultation with a registered dietitian and diabetes self management education, when possible. New pharmacotherapies for type 2 diabetes by brian irons, pharm. General approach to the management of type 2 diabetes mellitus. The epidemic of type 2 diabetes in the latter part of the 20th and in the early 21st century, and the. Pdf management of hyperglycemia in type 2 diabetes. Initial management of blood glucose in adults with type 2 diabetes. A number of landmark randomized clinical trials established that insulin therapy reduces microvascular complications 1, 2. A systematic evaluation of the literature since 2014 informed new recommendations. Type 2 diabetes mellitus dm is a common disease affecting 30. Diagnosis and management of type 2 diabetes mellitus in adults.
Further management of persistent hyperglycemia and other therapeutic issues, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. Nevertheless, implementation of insulin therapy is often delayed in patients with type 2 dm. Management of hyperglycemia in type 2 diabetes, 2018. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neu. Longer survival of patients with type 2 diabetes and develop. Objective type 2 diabetes is associated with defects in insulin secretion and insulin action. Management of noninsulindependent diabetes mellitus niddm requires teamwork. This delay can increase the risk of dmrelated complications, including microvascular neuropathy, nephropathy, retinopathy, and. Management of type 2 diabetes mellitus with basalprandial. See insulin therapy in type 2 diabetes mellitus, section on initial treatment.
Management of patients with type 2 diabetes mellitus includes education, evaluation for microvascular and macrovascular complications, achievement of target glycemia, treatment of cardiovascular and other longterm risk factors, and avoidance of drugs that can aggravate abnormalities of. Pharmacoeconomic analyses of clinical trials are needed to determine costeffective treatment strategies for management of type 2 diabetes. Initial combination therapy with metformin, pioglitazone and exenatide is more effective than sequential addon therapy in subjects with newonset diabetes. Evidencebased guidelines for the treatment of type 2 diabetes mellitus focus. Good diabetes management and careful monitoring of your blood glucose are both very effective means for preventing hyperglycemia or stopping it before it.
Pramlintide can reduce insulin requirements by up to 50%. The use of sulfonylurea agents is not recommended due to. Diabetes mellitus currently affects 17 million americans, and the incidence of this disease is still on the rise. The early treatment of type 2 diabetes american journal of. Screening for and prevention of diabetes, the etiologic classification of diabetes mellitus, the treatment of diabetes, as well as diabetes during pregnancy are discussed separately. Initially the idf guidelines task force members proposed the questions that were considered. Targeting and monitoring glycemic control in nonpregnant adults with diabetes mellitus. Pramlintide can be used by patients taking insulin, metformin, or sulfonylureas. Introduction treatment of patients with type 2 diabetes mellitus includes education, evaluation for micro and macrovascular complications, attempts to achieve near normoglycemia, minimization of cardiovascular and other longterm risk factors, and avoidance of drugs that can exacerbate abnormalities of insulin or lipid metabolism. Striking increases in the prevalence of type 2 diabetes mellitus t2dm are now being noticed in both youth and in individuals in the 30 to 40yearold age group. Management of elevated low density lipoproteincholesterol ldlc in primary prevention of cardiovascular disease. Often such patients do not need to be admitted after initial stabilization and treatment. A 57yearold white man with hypertension, hypercholesterolemia, and a 12year history of type 2 diabetes mellitus returned for followup. Download citation initial management of glycemia in type 2 diabetes mellitus an asymptomatic 45yearold hispanic man has a fasting plasma glucose level of 142 mg per deciliter 7.
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