Management of Hyperglycemia in Type 2 Diabetes
Management of Hyperglycemia in Type 2 Diabetes
The panoply of treatment algorithms, periodically released to improve guidance, is one means to face therapeutic uncertainty in pharmacological management of hyperglycemia in type 2 diabetes, especially after metformin failure. Failure of recent guidelines to give advice on the use of specific antidiabetic drugs in patients with co-morbidity may generate further uncertainty, given the frequent association of type 2 diabetes with common comorbidity, including, although not limited to obesity, cardiovascular disease, impaired renal function, and frailty. The Italian Association of Diabetologists (Associazione Medici Diabetologi, AMD) recognized the need to develop personalized treatment plans for people with type 2 diabetes, taking into account the patients' individual profile (phenotype), with the objective of the safest possible glycemic control. As not every subject with type 2 diabetes benefits from intensive glycemic control, flexible regimens of treatment with diabetes drugs (including insulin) are needed for reaching individualized glycemic goals. Whether personalized diabetology will improve the quality healthcare practice of diabetes management is unknown, but specific research has been launched.
In 2011, there were 366 million people with diabetes worldwide, and this is expected to rise to 552 million by 2030, rendering previous estimates very conservative. Diabetes increases the risk of disabling and life-threatening complications from micro and macrovascular disease. Diabetes is one of the first conditions for which disease-specific indicators based on practice guidelines have been used to "score" the quality of care and preventive services. Recent estimates in the US claim that about one half (48.7%) of persons with diabetes still did not meet the targets for glycemic control; only 14.3% met the targets for all three measures of glycemic control (HbA1c <7%), blood pressure (<130/80 mm Hg), or LDL cholesterol (<100 mg/dl) level. This scenario is still far from the objectives of glycemic therapies in type 2 diabetes which, in addition to achieving target HbA1c, ideally should: a) reverse one or more of the underlying pathophysiological processes, b) produce low unwanted effects, c) enhance quality of life of patients, and d) reduce diabetes micro and macrovascular complications, and diabetes-related mortality.
Abstract and Introduction
Abstract
The panoply of treatment algorithms, periodically released to improve guidance, is one means to face therapeutic uncertainty in pharmacological management of hyperglycemia in type 2 diabetes, especially after metformin failure. Failure of recent guidelines to give advice on the use of specific antidiabetic drugs in patients with co-morbidity may generate further uncertainty, given the frequent association of type 2 diabetes with common comorbidity, including, although not limited to obesity, cardiovascular disease, impaired renal function, and frailty. The Italian Association of Diabetologists (Associazione Medici Diabetologi, AMD) recognized the need to develop personalized treatment plans for people with type 2 diabetes, taking into account the patients' individual profile (phenotype), with the objective of the safest possible glycemic control. As not every subject with type 2 diabetes benefits from intensive glycemic control, flexible regimens of treatment with diabetes drugs (including insulin) are needed for reaching individualized glycemic goals. Whether personalized diabetology will improve the quality healthcare practice of diabetes management is unknown, but specific research has been launched.
Introduction
In 2011, there were 366 million people with diabetes worldwide, and this is expected to rise to 552 million by 2030, rendering previous estimates very conservative. Diabetes increases the risk of disabling and life-threatening complications from micro and macrovascular disease. Diabetes is one of the first conditions for which disease-specific indicators based on practice guidelines have been used to "score" the quality of care and preventive services. Recent estimates in the US claim that about one half (48.7%) of persons with diabetes still did not meet the targets for glycemic control; only 14.3% met the targets for all three measures of glycemic control (HbA1c <7%), blood pressure (<130/80 mm Hg), or LDL cholesterol (<100 mg/dl) level. This scenario is still far from the objectives of glycemic therapies in type 2 diabetes which, in addition to achieving target HbA1c, ideally should: a) reverse one or more of the underlying pathophysiological processes, b) produce low unwanted effects, c) enhance quality of life of patients, and d) reduce diabetes micro and macrovascular complications, and diabetes-related mortality.
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