Achieving Glycemic Control in Type 2 Diabetes: A Practical Guide for Clinicians on Oral Hypoglycemics

Abstract

Type 2 diabetes mellitus has reached epidemic proportions in the United States. Cardiovascular morbidity and mortality are particularly high in this patient population. Improved glucose control, especially early in the course of diabetes, can slow or prevent complications, preserve beta-cell function, and improve long-term outcomes. Within the last decade, new treatments and glycemic goals have created an opportunity to better manage this prevalent, chronic disease. Defects of insulin resistance and deficiency leading to type 2 diabetes can now be directly targeted with available therapies. In addition to diet and exercise, oral treatment options have been broadened, with both insulin secretagogues and insulin sensitizers. These advances in treatment options make glycemic control an obtainable target, and therefore should improve overall morbidity and mortality for patients. This paper will review currently available oral therapies, with a focus on the unique attributes of the insulin sensitizers for patients with type 2 diabetes.

Progressive resistance exercise improves glycaemic control in people with type 2 diabetes mellitus: a systematic review

“…Oral hypoglycaemic medications can reduce glycosylated haemoglobin by 0.5% to 2% (Willett et al 2004). These medications can be costly and are commonly associated with gastrointestinal side-effects (flatulence, nausea, diarrhoea, and abdominal pain) and weight gain (Willett et al 2004). Their efficacy also declines over time by 0.2% to 0.3% each year (Horan et al 2006).…”

GPR40‐induced insulin secretion by the novel agonist TAK‐875: first clinical findings in patients with type 2 diabetes

“…Persistent uncontrolled hyperglycaemia is universally accepted as a major contributing factor to the increased macrovascular and microvascular complications in patients with diabetes, and various antidiabetic agents have been developed to improve glycaemic control [1]. For example, insulin secretagogues have been widely used in clinical practice and selectively target ATP-regulated K + (K ATP ) channels in the plasma membrane of pancreatic β-cells, stimulating endogenous insulin secretion [2,3]. This action is independent of blood glucose concentrations and may increase the risk of hypoglycaemia [3,4].…”