Updated Guidelines For The Treatment Of Type 2 Diabetes
Posted Dec 01 2009 10:04pm
The American Association of Clinical Endocrinologists (AACE) has updated its recommendations regarding the treatment of Type 2 diabetes and these now include the newer medications.
Some of the more interesting, and more realistic, recommendations include:
▸ Lifestyle modifications (diet and exercise) are critical, but delaying medication therapy waiting for lifestyle modifications to take effect is likely to be inadequate.
▸ The HbA1c goal of 6.5% is important, but must be individualized for individual patients with considerations given to other medical problems, problems with hypoglycemia (low blood sugar) and limited life expectancy.
▸ Therapy effectiveness must be evaluated frequently, typically every 2–3 months.
▸ Safety and efficacy should be given greater priority than cost of medications -- this may be the most useful of the updated recommendations. The insurance companies make it as difficult as possible for us to use the newer, safer (not causing hypoglycemia), but more expensive medications (BYETTA, JANUVIA and ONGLYZA). We discuss with patients that the avoidance of one emergency evaluation (paramedics or emergency room) for hypoglycemia will easily cover the increased cost of these medications for a year or more (not to mention the reduction of additional risks and problems that may be associated with a hypoglycemic event).
▸ Rapid-acting insulin analogues (APIDRA, NOVOLOG and HUMALOG) are a better, superior alternative to “regular human insulin.”
▸ Similarly, long-acting synthetic analogues (LANTUS and LEVEMIR) yield better reproducibility and consistency as basal insulins than does NPH, which is not primarily recommended outside of special individual needs.
The full Clinical Endocrinology News article ishere.