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New Drugs for Type 2 DiabetesUntil recently, there were few medications (only sulfonylureas or insulin) available for the treatment of type 2 diabetes (also known as non-insulin dependent or adult-onset diabetes). But today, doctors have a wide variety of new types of drugs to help you regulate your blood glucose (sugar). In this article, we will look at all these medications and describe how they work.
Although we have little understanding of the underlying causes of type 2 diabetes, we now know that there are many different reasons why those who suffer from type 2 diabetes cannot control their blood sugar. Some do not produce enough insulin, the hormone that regulates blood sugar. Others produce enough insulin but are somehow resistant to its action. It is also known that the livers of patients with type 2 diabetes produce excess glucose and that this, too, can contribute to high blood glucose levels.
Type 2 Diabetes Is Not Only a Disease of Carbohydrate MetabolismPatients with type 2 diabetes often have many associated disorders, including hypertension (high blood pressure), obesity, hyperlipidemia (excess fat in the blood) and accelerated atherosclerosis (damaged arteries caused by fatty deposits). Diabetes may worsen these disorders. For this reason, it is important to treat both the diabetes and the associated disorders together. Treatment goals for hypertension and hyperlipidemia are now included in all ADA (American Diabetes Association) recommendations for diabetes management.
The presence of these associated disorders needs to be considered when choosing antidiabetic medications. A prime example is associated hyperlipidemia. Some anti-hyperglycemic agents, i.e., drugs that bring down blood glucose levels, also have beneficial effects on lipid (fat) disorders and may, therefore, be the best choice for patients who suffer from both conditions.
Not by Drugs AloneIt must be remembered, even though the emphasis of this article is on drug treatments, that medications should never be used without non-drug therapies, such as diet, a regimen of physical activity and patient education. Newly diagnosed diabetic patients without severe symptoms should always try diet and exercise first. And even when drug treatment has begun, life-style changes and education remain an important part of managing diabetes.
Goals of TherapyCareful control of blood sugar reduces the long-term effects of type 2 diabetes on the body's circulatory system. We have learned a great deal about this from two recent studies (the Diabetes Control and Complications Trial [DCCT] study and the U.K. Prospective Diabetes Study [UKPDS]). As a result of these important large-scale research studies, the ADA has set new therapeutic goals. These include a target level of 7% for HbA1c (glycated hemoglobin - a measure of blood glucose control that provides information about average glucose levels over months rather than minutes or hours, which is all the information that blood glucose levels can provide); 80 - 120 mg/dl (4.4-6.6 mmol/l) for fasting plasma glucose (FPG); and 100-180 mg/dl (5.5-10 mmol/l) for postprandial (after eating a meal) glucose.
When you start on an oral drug treatment, it is important that you see your doctor at least every 2-4 weeks, so you can quickly be placed on the best dose of the medicine. Frequent visits, at the start of treatment, may, if necessary, also help the doctor determine whether another medication should be added without delay.
Classes of Agents Available for Treatment of Type 2 Diabetes
HGP, hepatic glucose production
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