Treatment of Type 2 Diabetes

Abstract

Two recent developments have served to refocus attention on the treatment of type 2 diabetes mellitus. First, the prevalence of the disease is increasing at an alarming rate, including in pediatric populations. Second has been the demonstration that intensive pharmacotherapy of the disease has a dramatically beneficial effect on its outcome. Control of hyperglycemia is not the only goal of therapy. In fact, the control of associated obesity, hypertension, and dyslipidemia may be as beneficial, if not more so, for longterm outcomes than is the regulation of glycemia. Furthermore, there well may be shared features in the pathogenesis of these and other comorbidities associated with the “metabolic syndrome,” making a separation of their treatment from those aimed at normoglycemia per se somewhat artificial. For example, most treatments that augment insulin action will lower serum triglycerides, other drugs may have direct cardiovascular effects that contribute to their overall beneficial effect, and certain antihypertensives can affect glucose homeostasis. However, this chapter will focus only on achieving normoglycemia. For further details on integrated diabetes care, such as surveillance and treatment of complications, or nutritional recommendations, the reader should consult more comprehensive sources such as the Clinical Practice Recommendations of the American Diabetes Association, published annually as a supplement to the journal Diabetes Care or available at their website (http://www.diabetes.org). The reader is also encour-aged to consult the many excellent texts and review articles available on specific aspects of treatment or agents mentioned below.