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ADA recommends treating type 2 diabetes more aggressively

Posted Oct 31 2008 7:58am

I could be snide and say, "Well, that only took a million years" or I could be thankful and say a lot of patients should now live longer with less complications.

In an article, "New Major Changes in Recommendations for the Treatment of Type 2 Diabetes by ADA and EASD" that appeared in DiabetesInControl, an online newsletter for health professionals, the ADA has issued new recommendations for treating type 2 diabetes more aggressively. 

What motivates the change appears to be the conclusion, "that much of the morbidity associated with long-term microvascular and neuropathic complications can be substantially reduced by interventions that achieve glucose levels close to the non-diabetic range. Although new classes of medications and numerous combinations have been demonstrated to lower glycemia, current-day management has failed to achieve and maintain the glycemic levels most likely to provide optimal healthcare status for people with diabetes."

Translation: Yea, we got new medicines to keep blood sugar in control but most people's blood sugar still isn't in control. 

So new ADA health-care providers therapeutic recommendations are to speed the introduction of insulin:

Step 1 -- Lifestyle intervention and use of metformin because of its effect on glycemia, absence of weight gain or hypoglycemia, good tolerability profile and relatively low cost. 

Step 2 -- Add another medication, either insulin or a sulfonylurea,within 2 to 3 months of starting step 1or at any time when target hemoglobin A1c level is not achievedor if metformin is contraindicated or poorly tolerated. For patients who have hemoglobin A1c level of more than 8.5% or symptoms secondary to hyperglycemia, insulin is preferred, typically a basal (intermediate- or long-acting) insulin. 

Step 3 -- Further adjustments by starting or intensifying insulin therapy with additional injections that might include a short- or rapid-acting insulin given before selected meals to curtail postprandial hyperglycemia. 

David M. Nathan, MD, from the Diabetes Center of Massachusetts General Hospital in Boston says, "The epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can substantially reduce morbidity, have made the effective treatment of hyperglycemia a top priority." wasn't before? Oops, there goes my snide side. Hard for a type 1 to fathom the laxity in treating type 2 diabetes. "Maintaining glycemic levels as close to the non-diabetic range as possible," continued Nathan, "has been demonstrated to have a powerful beneficial effect on diabetes-specific microvascular complications, including retinopathy, nephropathy, and neuropathy, in the setting of type 1 diabetes; in type 2 diabetes, more intensive treatment strategies have likewise been demonstrated to reduce microvascular complications."

We can only hope physicians will know the new recommendations and patients will get effective treatment. If I were a type 2 I'd ask my health care provider for the best treatment to control my blood sugar to normal levels, whether it's with a pill or a syringe. For most of us, it'll mean more years on the planet and spending them happier and healthier.

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