New Concepts in Type 2 Diabetes Management

by Cindy

Updated Guidelines for Type 2 Diabetes Management

Just this month Diabetes Care published updated management protocols stressing the importance of individualized, patient centered diabetic management.  The biggest take home point from this publication is the emphasis that is being placed on treating each diabetic patient as an individual and remembering that not all patients will respond in the same way to each treatment plan.  With these concepts in mind, it is the goal of the physician to find an treatment plan that works for you and doesn’t simply fit into a set guideline. So what exactly has changed?

Less Aggressive Diabetic Treatment Goals For Certain Patients

In order for type 2 diabetics to successfully manage their condition, these patients need to be on-board with the treatment plan.   The basic treatment guidelines have not changed.  For most, the goal of treatment will continue to target a hemoglobin a1c of less than 7%.  However for certain patients less aggressive goals may be considered.   Your treatment goals will likely be determined based on the following factors:

  • Involvement in your own care and willingness to participate in active management
  • Risk of low blood sugar
  • How long you have had diabetes
  • Life expectancy
  • Other health conditions and complications

Individualized Diabetic Treatment Plans

The basic concepts of lifestyle modification which includes dietary changes, routine exercise and weight loss, have not changed.  All patients are strongly encouraged to improve their lifestyle and also to seek counseling from a certified diabetic educator.  In addition, Metformin remains the first choice medication for all type 2 diabetics.  However, when it comes to choosing additional medications to meet a1c treatment goals, more emphasis is to be placed on meeting the individual’s needs while considering factors such as:

  • How well the medication improves blood sugar levels
  • Side effects and tolerability of the medication
  • Cost of the medication
  • Weight gain or loss secondary to use of the medication
  • Risk of hypoglycemic events while on the medication

The overall concepts have not changed and really only serves as a reminder to physicians to treat the whole patient and not just the condition.  Most health care providers already adapt their plans to suit individual needs.  Personally, I often cannot answer a generic “what medications do you typically prescribe for condition xyz” with specifics.  My answer has always been and will continue to be “it depends on the patient.”

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