Management of blood glucose in type 2 diabetes mellitus

Cynthia M. Ripsin, Helen Kang, Randall Urban

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Evidence-based guidelines for the treatment of type 2 diabetes mellitus focus on three areas: intensive lifestyle intervention that includes at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet; aggressive management of cardiovascular risk factors (i.e., hypertension, dyslipidemia, and microalbuminuria) with the use of aspirin, statins, and angiotensin-converting enzyme inhibitors; and normalization of blood glucose levels (hemoglobin A1C level less than 7 percent). Insulin resistance, decreased insulin secretion, and increased hepatic glucose output are the hallmarks of type 2 diabetes, and each class of medication targets one or more of these defects. Metformin, which decreases hepatic glucose output and sensitizes peripheral tissues to insulin, has been shown to decrease mortality rates in patients with type 2 diabetes and is considered a first-line agent. Other medications include sulfonylureas and nonsulfonylurea secretagogues, alpha glucosidase inhibitors, and thiazolidinediones. Insulin can be used acutely in patients newly diagnosed with type 2 diabetes to normalize blood glucose, or it can be added to a regimen of oral medication to improve glycemic control. Except in patients taking multiple insulin injections, home monitoring of blood glucose levels has questionable utility, especially in relatively well-controlled patients. Its use should be tailored to the needs of the individual patient.

Original languageEnglish (US)
JournalAmerican Family Physician
Volume79
Issue number1
StatePublished - Jan 1 2009

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Type 2 Diabetes Mellitus
Blood Glucose
Insulin
Blood Glucose Self-Monitoring
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Glucose
Thiazolidinediones
Metformin
Liver
Dyslipidemias
Angiotensin-Converting Enzyme Inhibitors
Aspirin
Insulin Resistance
Life Style
Weight Loss
Hemoglobins
Fats
Guidelines
Exercise
Diet

ASJC Scopus subject areas

  • Family Practice

Cite this

Management of blood glucose in type 2 diabetes mellitus. / Ripsin, Cynthia M.; Kang, Helen; Urban, Randall.

In: American Family Physician, Vol. 79, No. 1, 01.01.2009.

Research output: Contribution to journalArticle

Ripsin, Cynthia M. ; Kang, Helen ; Urban, Randall. / Management of blood glucose in type 2 diabetes mellitus. In: American Family Physician. 2009 ; Vol. 79, No. 1.
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