Treatment of type 2 diabetes mellitus Review article
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Abstract
Increased insulin resistance and impaired insulin secretion, are the main pathophysiological features of type 2 diabetes, but impaired insulin secretion is generally progressive. The major environmental factors that increase the risk of type 2 diabetes are overnutrition and a sedentary lifestyle, with consequent overweight and obesity. Lifestyle changes including diet modification, increase in physical activity, weight reduction in the overweight and smoking cessation are essential components of the management of type 2 diabetes. Metformin is generally considered the first choice oral medication, unless contraindicated. A second oral agent of another class or insulin may be added if metformin is not sufficient. Other classes of medications include: sulfonylureas, thiazolidinediones-pioglitazone, dipeptidyl peptidase-4 inhibitors, SGLT-2 inhibitors, and glucagon-like peptide-1 analog.
If A1C target not achieved of dual therapy proceed to 3-drug combination. Due to the progressive nature of type 2 diabetes, insulin therapy is eventually indicated for many patients with type 2 diabetes. Basal insulin alone is the most convenient initial insulin regimen and insulin is usually prescribed in conjunction with metformin and possibly one additional noninsulin agent.
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