Medscape J Med. 2008 Jun 18;10(6):143; quiz 143.
The changing shape of type 2 diabetes.
Medscape journal of medicine
Stephen A Brunton
Affiliations
Affiliations
- Stamford Hospital, Columbia University, Charlotte, North Carolina; Cabarrus Family Medicine Residency Program, Concord, North Carolina, USA.
PMID: 18679554
PMCID: PMC2491685
Abstract
CONTEXT: Type 2 diabetes is primarily a disease that affects late-middle-aged and elderly individuals. Due to increasing affluence, lifestyle changes, and obesity, however, it is also affecting younger age groups. Therefore, treatment recommendations may need to be revised to reflect these changes. Fortunately, various new treatment options, including insulin analogs with more physiologic time-action profiles and drugs that target the incretin system, are now available.
EVIDENCE ACQUISITION: This review was based on a PubMed literature search done in August 2007, using relevant search terms.
EVIDENCE SYNTHESIS: Improving diet and increasing physical activity are important therapeutic interventions in diabetes and associated conditions. However, many people find it difficult to maintain lifestyle changes, which is why the American Diabetes Association recommends lifestyle intervention plus metformin following initial diagnosis. Current guidelines recommend a stepwise approach, with additional oral antidiabetic drugs (OADs) being added as the disease progresses. Insulin therapy should be initiated once OADs fail to control hyperglycemia, as there is good evidence that intensive therapy, with strict glycemic targets, can reduce the long-term microvascular complications that are associated with poorly controlled diabetes. In addition, while the evidence is less conclusive, intensive therapy may also improve long-term macrovascular comorbidities.
CONCLUSIONS: It is important that patients with diabetes receive the most effective therapy for maintaining glycemic control and that treatment is modified or augmented in those who are not achieving appropriate glycemic goals. Only by maintaining long-term, effective glycemic control can the microvascular and macrovascular comorbidities associated with diabetes be minimized.
References
- Med J Aust. 2007 May 7;186(9):461-5 - PubMed
- Lancet. 1999 Aug 21;354(9179):617-21 - PubMed
- Am J Manag Care. 2007 Apr;13 Suppl 2:S47-54 - PubMed
- Endocrinol Metab Clin North Am. 2006 Dec;35 Suppl 1:3-5; discussion 17-19 - PubMed
- Diabetes Obes Metab. 2005 Jan;7(1):56-64 - PubMed
- Clin Chem Lab Med. 2003 Sep;41(9):1266-78 - PubMed
- Nutr Health. 1997;11(3):149-57 - PubMed
- Nat Rev Drug Discov. 2006 Nov;5(11):919-31 - PubMed
- Diabetes Care. 2004 May;27(5):1047-53 - PubMed
- Mayo Clin Proc. 2003 Apr;78(4):411-3 - PubMed
- Eur J Endocrinol. 2004 Oct;151 Suppl 2:T23-7; discussion T29-30 - PubMed
- N Engl J Med. 2005 Dec 22;353(25):2643-53 - PubMed
- Aust N Z J Public Health. 2007 Apr;31(2):177-83 - PubMed
- Nature. 2001 Dec 13;414(6865):782-7 - PubMed
- Curr Pharm Des. 2001 Sep;7(14):1303-25 - PubMed
- J Clin Endocrinol Metab. 2000 Aug;85(8):2970-3 - PubMed
- Diabetes Care. 2004 Jun;27(6):1335-42 - PubMed
- Am J Hum Genet. 1962 Dec;14:353-62 - PubMed
- Neth J Med. 2007 Feb;65(2):60-4 - PubMed
- Indian J Med Res. 2007 Mar;125(3):345-54 - PubMed
- Biomed Environ Sci. 2002 Sep;15(3):245-52 - PubMed
- Lancet. 2006 Nov 11;368(9548):1673-9 - PubMed
- Lancet. 1998 Sep 12;352(9131):837-53 - PubMed
- BMJ. 2006 Aug 19;333(7564):362-3 - PubMed
- N Engl J Med. 2007 Jul 5;357(1):28-38 - PubMed
- Am J Clin Nutr. 2003 Dec;78(6):1120-7 - PubMed
- N Engl J Med. 2007 Feb 1;356(5):437-40 - PubMed
- Diabetes Care. 1997 Jul;20(7):1183-97 - PubMed
- J Pediatr. 2005 May;146(5):693-700 - PubMed
- J Clin Endocrinol Metab. 2001 Jun;86(6):2899-902 - PubMed
- JAMA. 2003 Oct 8;290(14):1884-90 - PubMed
- Diabetes Care. 2006 Sep;29(9):2114-6 - PubMed
- JAMA. 2006 Apr 5;295(13):1549-55 - PubMed
- Clin Drug Investig. 2007;27(4):279-85 - PubMed
- N Engl J Med. 2007 Jun 14;356(24):2457-71 - PubMed
- Am J Clin Nutr. 2004 Jul;80(1):51-7 - PubMed
- Rev Diabet Stud. 2005 Spring;2(1):35-9 - PubMed
- Lancet. 2007 May 26;369(9575):1823-1831 - PubMed
- Metab Syndr Relat Disord. 2004 Jun;2(2):105-13 - PubMed
- Diabetologia. 2004 Apr;47(4):622-9 - PubMed
- Endocr Pract. 2007 May-Jun;13(3):260-8 - PubMed
- Diabetes. 2006 Apr;55(4):1114-20 - PubMed
- Proc Nutr Soc. 2007 Feb;66(1):82-95 - PubMed
- Diabetes Care. 1997 Apr;20(4):537-44 - PubMed
- Clin Ther. 2006 Oct;28(10):1569-81 - PubMed
- Diabetes Obes Metab. 2007 May;9(3):418-27 - PubMed
- J Investig Med. 2007 Mar;55(2):62-8 - PubMed
- JAMA. 2002 May 15;287(19):2563-9 - PubMed
- Diab Vasc Dis Res. 2007 Mar;4(1):32-8 - PubMed
- Circulation. 2005 Mar 22;111(11):1448-54 - PubMed
- Clin Ther. 2003 Nov;25(11):2836-48 - PubMed
- J Clin Invest. 1999 Sep;104(6):787-94 - PubMed
- Diabetes Care. 2003 Nov;26(11):3160-7 - PubMed
- Diabetes Care. 2007 Jun;30(6):1487-93 - PubMed
- N Engl J Med. 2002 Feb 7;346(6):393-403 - PubMed
- Diabetes Care. 1997 May;20(5):844-7 - PubMed
- MedGenMed. 2007 Apr 16;9(2):12 - PubMed
- BMJ. 2000 Aug 12;321(7258):405-12 - PubMed
- Diabetes Care. 2006 Aug;29(8):1963-72 - PubMed
- Diab Vasc Dis Res. 2006 May;3(1):7-11 - PubMed
- N Engl J Med. 2002 Mar 14;346(11):854-5 - PubMed
- Diabetes Care. 1999 Jun;22(6):920-4 - PubMed
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