Treatment of Type 2 Diabetes Mellitus
JOE A. FLORENCE, M.D., and BRYAN E YEAGER, PHARM.D.
University of Kentucky College of Medicine, Lexington, Kentucky
Type 2 diabetes mellitus (formerly called non-insulin-dependent diabetes) causes
abnormal carbohydrate, lipid and protein metabolism associated with insulin resistance
and impaired insulin secretion. Insulin resistance is a major contributor to progression
of the disease and to complications of diabetes. Type 2 diabetes is a common
and underdiagnosed condition that poses treatment challenges to family practitioners.
The introduction of new oral agents within the past three years has expanded the
range of possible combination regimens available for treating type 2 diabetes. Despite
the choice of pharmacologic agents, physicians must stress the nonpharmacologic
approaches of diet modification, weight control and regular exercise. Pharmacologic
approaches must be based on patient characteristics, level of glucose control and cost
considerations. Combinations of different oral agents may be useful for controlling
hyperglycemia before insulin therapy becomes necessary. A stepped-care approach to
drug therapy may provide the most rational, cost-efficient approach to management
of this disease. Pharmaco-economic analyses of clinical trials are needed to determine
cost-effective treatment strategies for management of type 2 diabetes.