A comprehensive management guide has been developed for clinicians in the treatment of patients with type-2 diabetes
The American Association of Clinical Endocrinologists and American College of Endocrinology have released a 2016 management guide for clinicians in the treatment of type 2 diabetic (T2D) patients that considers the whole patient, risk factors, complications, and evidence-based treatment approaches. This guide discusses the following main topics:
Lifestyle therapy is considered essential for all diabetic patients. Nutrition counselling and education help patients maintain an optimal weight through a plant-based diet that avoids trans and saturated fats, and to keep a consistent carbohydrate intake. Regular sleep and physical activity like walking or stairclimbing each week can improve overall wellness, glucose control, lipid levels and blood pressure. Seeking emotional and motivational support through a community group, family, or friends is also recommended. Patients with obesity or complications should follow a more structured program.
Weight loss should be considered for all overweight or obese T2D patients, as weight loss will lower glycemia and lipid levels, reduce blood sugar, and decrease strain on lower body parts like the hips and knees. In addition to lifestyle therapy, physicians should assess patient BMI, risks, benefits, and medical outcomes that address obesity complications prior to setting individualized weight loss goals. Certain patients may also benefit from weight-loss medication or medical and surgical intervention.
Prediabetes occurs when pancreatic beta cells are not able to function properly. It is commonly caused by excess body weight and obesity, and can eventually lead to type 2 diabetes and cardiovascular disease. However, this can be prevented or improved through weight loss. Antihyperglycemic medications can be helpful for patients who are unsuccessful with traditional strategies.
For T2D patients and their physician, the guide supports the collaborative development of individual patient glycemic and haemoglobin A1C goals in combination with an approach that factors characteristics such as age, comorbidities, and hypoglycemia risk. The decision to control glucose using insulin or noninsulin antihyperglycemic therapies should involve agents with complementary actions, and is highly dependent on patient characteristics, motivation, personal preferences, and the impact of cost to the patient. The therapeutic regimen should be as simple as possible to optimize adherence and be evaluated frequently until stable. Proper blood glucose control is critical to prevent vascular complications that can lead to heart disease.
Management of Blood Pressure
T2D patients with hypertension have a higher risk of developing atherosclerotic cardiovascular disease (ASVD) or having a stroke. Individualized blood pressure management and goals should be combined with lifestyle therapies including weight loss, exercise, and sodium restriction. Most T2D patients, however, will likely require blood pressure medications to achieve their goals in addition to lifestyle changes.
Management of Lipids
T2D patients have a higher lifetime risk for developing ASVD, and abnormal amounts of cholesterol and fat in the blood further increases that risk. The avoidance of risk factors such as smoking, hypertension, and fatty food consumption, and overall improvements to lifestyle mentioned in the categories above will help many T2D patients achieve their lipid target levels. Cholesterol-lowering drug therapies such as moderate- to high-intensity statins have been shown in practice to also help the patients reduce their cholesterol, but other lipid-modifying therapies can be used as well.
Executive summary of diabetes algorithm:
AJ Garber, MJ Abrahamson, JI Barzilay, L Blonde, ZT Bloomgarden, MA Bush, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm – 2016 Executive Summary. Endocrine Practice: January 2016, Vol. 22, No. 1, pp. 84-113, 2016.
Written by Fiona Wong, PhD