Treatment for Diabetes
All treatment strategies should emphasize on cardiovascular risk reduction focusing on control of blood pressure, smoking cessation and correction of dyslipidemia. Consumption of healthy diet, exercise and maintenance of optimal weight should be the cornerstone of management. According to the American Diabetes Association (ADA), the goals of diabetic treatment are the following:

Type 1 Diabetes Mellitus
Type 1 DM is managed with insulin injections along with a healthy diet. Diabetic patients are educated on how to inject themselves with insulin. Injections should be given subcutaneously. The amount of insulin must be balanced with food intake and daily activities. In addition, blood glucose levels must be closely monitored through frequent blood glucose checking.

There are different kinds of insulin treatments available. The human bio-engineered insulin is available in short-, medium- and long-acting varieties. The amount and timing of insulin injections are adjusted depending on the timing, amount and type of food eaten. Aversion for needles and patient anxiety related to injections are the main hurdle to insulin initiation or intensification leading to noncompliance of therapy.

A significant number of diabetics now resort to using an insulin pump as it provides an effective, easy-to-use and convenient method of insulin administration. Inhaled insulin is the latest addition in the management of diabetes and may be a viable alternative to subcutaneous insulin.¹ The insulin schedule and dosing should be reviewed at each consultation to review diabetes.

Type 2 Diabetes Mellitus
Diet modification and physical activity are the basic management strategy for T2DM. As the total amount of carbohydrateconsumed is a strong predictor of glycemic response, monitoring of total carbohydrate intake is the key strategy in achievingglycemic control. Foremost, people with DM should eat healthily food as recommended for the whole population, which is a balanced diet based on starchy foods, plenty of fruit and vegetables and food low in fat, salt and sugar.

In addition, many T2DM patients require OHAs, insulin or both in order to control their blood glucose levels.The OHAs include sulphonylureas (glibenclamide, glipizide, gliclazide, etc.), biguanides (metformin and phenformin), alpha-glucosidase inhibitors (acarbose), thiazolidinediones (rosiglitazone and pioglitazone) and meglitinides (repaglinide). The OHAs are indicated for its use as therapy only after the failure of diet, exercise and weight reduction strategies to control hyperglycemia.

Generally, sulfonylureas are prescribed as an initial therapy in nonobese patients. Biguanides are the preferred agents for obese patients or as an add-on therapy in patients whose blood glucose is not adequately controlled with sulfonylurea. An alpha-glucosidase inhibitor or thiazolidinedione can be prescribed as an alternative to a sulfonylurea or biguanide as an add-on therapy in patients with uncontrolled hyperglycemia or significant renal dysfunction.

The current approach to the management T2DM patients suggests that initiation of insulin therapy could be atarted if a combination of two oral agents (drug therapy) fails to provide adequate glycemic control. The synergistic effect of OHAs with insulin may allow the insulin dose to be reduced by up to 50%.² The insulin regimen should be tailored to the patient’s degree of hyperglycemia, the risks associated with hypoglycemia, comorbid conditions, the ability to adhere to a routine schedule and the cost.

Gestational Diabetes Mellitus
The commonly accepted treatment goal for GDM patients is to maintain a fasting blood glucose level of <95– 105 mg/dL and a postprandial blood glucose level of <140 mg/dL at 1 h and <120 mg/dL at 2 h. Patients not achieving these targets with dietary changes should be started on insulin therapy. In general, OHAs are not used during pregnancy because of the potential adverse effects on the fetus.

Women who have had GDM previously should be encouraged to maintain an optimal weight and to exercise regularly. They should be tested for diabetes once in 2 years basis. In women of reproductive age with T2DM, the menstrual history is very significant as some of them may also have polycystic ovarian syndrome. Treatment with metformin or a glitazone for their diabetes may help to restore the menstrual cycle as well as fertility.

 

Written by: Healthplus24 team
Date last updated: December 15,2008

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