Dialogue and Diagnosis - American Osteopathic Association

Dialogue
and
Diagnosis
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TAKE 10
When it comes to injectable
treatments for patients with type 2
diabetes, here are 10 points to
consider:
1. Despite the wide range of
medications to address the multiple
pathophysiologic defects in T2DM,
nearly 50% of people with diabetes
mellitus have poor control of their
disease.
2. Patients failing to initiate prescribed
insulin therapy commonly have
misconceptions regarding insulin
risk.
3. A physician’s attitudes, beliefs , and
knowledge about diabetes mellitus
can influence disease management.
Suspicion about the safety and
efficacy of current treatments may
be a barrier to aggressive manage -
ment. Insulin should be offered to
patients in a positive light as a
means to improve their health.
Reminding them early in the in the
disease that there may be times
insulin is needed in a pinch, such as
a critical illness or hospitalization,
may help.
4. Because T2DM is a progressive
disease, many patients will ultimately
need insulin therapy to achieve and
maintain adequate glycemic control.
Patients with T2DM, because of an
innate insulin resistance, tend to
require higher doses of insulin than
patient with type 1 diabetes mellitus.
5. Regarding glucose self-monitoring,
physicians should consider urging
measurements of fasting levels
and “bracketing” 1 meal with
preprandial and postprandial
measurements daily on a repetitive
basis.
6. When choosing the treatment option
for each patient, consider the
durations of T2DM, stage of the
disease, current level of control,
lifestyle habits, and attitude toward
disease management.
7. Today’s physicians are faced with
many more treatment options and
many more safety, efficacy, and
tolerability issues to consider then
personalizing treatment for patients
who require combination therapy in
addition to metformin as T2DM
progresses.
8. Metformin has become the
cornerstone of therapy on the basis
of its efficacy, low risk of hypo -
glycemia, low risk of weight gain,
and generic availability.
9. Ongoing therapeutic lifestyle
management should be discussed
with all patients with diabetes
mellitus throughout their lives.
Medical nutritional therapy must be
individualized, generally requiring
evaluation and teaching by a
trained nutritionist/registered
dietician or a knowledgeable
physician. Lifestyle intervention
remains the foundation of care of all
patients with diabetes mellitus, and
healthy lifestyle choices should be
addressed at every office visit.
10. If an incretin-based medication is
selected it is important to review
the safety issues with the patient.