Type II diabetes is a metabolic disease in which cells of the body no longer respond well to the hormone insulin, and insulin is not secreted in sufficient amounts by cells in the pancreas. The American Diabetes Association and the European Association for the Study of Diabetes published a consensus algorithm for the treatment of type II diabetes in the August 2006 issue of "Diabetes Care". The treatment goal emphasized is to maintain an A1C level below 7.0 percent. A1C level refers to the level of glucose modified hemoglobin and provides information on a person's average blood glucose level over a two to three month time period.
Anti-diabetic Medications
Anti-diabetic medications reduce blood glucose levels by increasing insulin secretion, increasing insulin sensitivity, decreasing liver glucose production or decreasing carbohydrate digestion and absorption. They are also known as hypoglycemic drugs and there are currently eight classes of anti-diabetic medications on the market. They include alpha-glucosidase inhibitors, amylin agonists, biguanides, dipeptidyl-peptidase 4 inhibitors, meglitinides, sulfonylureas, incretin mimetics and thiazolidinediones. The American Diabetes Association recommends metformin, a biguanide, as the initial pharmacotherapy for the treatment of type II diabetes. If lifestyle intervention and metformin do not reduce A1C levels below 7 percent then another anti-diabetic drug may become necessary. The American Association of Clinical Endocrinologists and American College of Endocrinology recommends earlier and more frequent use of the incretin mimetic, GLP-1 and the DPP-4 inhibitors because of their effectiveness and overall safety profiles.
Insulin Therapy
A clinical trial study reported in 2009 in the journal, "Diabetes, Obesity and Metabolism", says that insulin therapy improved glucose control in type II diabetics that no longer responded to oral anti-diabetic medications. Instead of prescribing a second anti-diabetic medication to type II diabetics that do not respond to lifestyle intervention and metformin, the American Diabetes Association suggests insulin therapy may prove effective in reducing blood glucose levels. There are many different types of synthetic insulin and they differ by how fast the insulin acts and how long it remains in the body. They include rapid-acting insulin, short-acting insulin, intermediate-acting insulin and long-acting insulin. The American Diabetes Association recommends initial therapy with intermediate- and long-acting insulins.
Macrovascular Medications
Macrovascular disease refers to large vessel disease and includes coronary disease, cerebrovascular disease and peripheral vascular disease. A review of several clinical trials published in the April 2004 issue of "Annals of Internal Medicine" found that the main complication of type II diabetes is cardiovascular disease and up to 80 percent of type II diabetics will develop cardiovascular disease. The authors further suggest that type II diabetics should be treated with the lipid-lowering statins as type II diabetics treated with lipid-lowering drugs had between a 22 and 24 percent reduction in cardiovascular events. A review of clinical studies from 1950 to 2009 published in the September 2009 issue of "Annals of Internal Medicine" reports that to curtail the risk of cardiovascular disease in type II diabetics health care providers should not only focus on decreasing blood glucose levels but also combine drug therapies to reduce hypertension and macrovascular disease.
Microvascular Medications
The microvascular complications of type II diabetes include diabetic neuropathy, diabetic nephropathy and diabetic retinopathy. In contrast to the risk of macrovascular complications, the risk of developing microvascular complications is strongly correlated to the A1C levels of type II diabetics. A review study of multiple large-scale clinical trials published in February 2010 reported that controlling blood glucose levels is protective against the microvascular complications of type II diabetes, especially nephropathy. Additionally, a March 2010 review published in the "American Journal of Medicine" recommends the early management of hyperglycemia to prevent or delay microvascular complications.
References
- "Diabetes Care": Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy.
- "Endocrine Practice": Statement by an American Association of Clinical Endocrinologists /American College of Endocrinology Consensus Pane l on Type 2 Diabetes Mellitus: An Algorithm for Glycemic Control.
- "Diabetes, Obesity and Metabolism": Comparison of insulin analogue regimens in people with type 2 diabetes mellitus in the PREFER Study: a randomized controlled trial.
- "Annals of Internal Medicine": Pharmacologic Lipid-Lowering Therapy in Type 2 Diabetes Mellitus: Background Paper for the American College of Physicians.
- Pubmed.gov: "American Journal of Medicine": Glycemic control and complications in type 2 diabetes mellitus.
