Treatment
The major treatment goals for people with type 2 diabetes are twofold:
- To treat all conditions that place the patients at risk for heart disease and stroke, which are the major killers of people with type 2 diabetes.
- To control blood glucose levels. The goal is to achieve fasting blood glucose levels of less than 110 mg/dl and glycolated hemoglobin (HbA1c) levels of less than 7%. The objective is to reduce complications in small blood vessels and the nerve damage associated with diabetes.
An intensive multi-pronged approach is critical for reducing complications and improving survival rates in diabetics. In one major study, patients with diabetes and early signs of kidney involvement embarked on an intensive preventive program. At the end of about seven years, their risk for heart, stroke, death, and other complications was 24% compared to 44% of patients who had conventional therapy. Intensive therapy involved the following:
- Healthy lifestyle changes: Exercise for 30 minutes three to five times a week; low-fat diet; smoking cessation; vitamins and mineral supplements (vitamin E and C, folic acid, and chrome picolinate).
- Controlling blood sugar levels. The use of an oral anti-hyperglycemic agent, such as a sulfonylurea or metformin (Glucophage), for patients whose HbA1c levels were over 6.5%. Of note, studies suggest that metformin significantly reduces mortality rates compared to other agents, including insulin. It should be considered as the first option in managing blood sugar for most patients with type 2 diabetes. Other oral anti-hyperglycemic agents (OHAs) are also available. Insulin may eventually be needed.
- Taking heart protective agents. Among anti-hypertensive agents angiotensin converting enzyme (ACE) inhibitors are first choice for diabetics, particularly those with evidence of kidney problems--even without high blood pressure. Controlling high blood pressure, in fact, is one of the few factors proven to reduce mortality rates. Among cholesterol-lowering agents, statins are the first choice alone or in combinations. They protect people with diabetes, even if cholesterol levels are not abnormal. Aspirin is important to prevent blood clots and heart attack.
Of note, most people with diabetes would find such intensive treatment difficult to comply with. Still, they should make every effort, especially to control blood pressure, cholesterol levels, and blood glucose levels.
Treating Special Populations
Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions. Treating children with type 2 diabetes depends on the severity of the condition at diagnosis. Metformin is now approved for children. Until recently, only insulin was approved for treating children with any diabetes.
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