Oral pharmacologic management of type 2 diabetes.
Epidemiologic and interventional studies have led to lower treatment targets for type 2 diabetes (formerly known as non-insulin-dependent diabetes), including a glycosylated hemoglobin level of 7 percent or less and a before-meal blood glucose level of 80 to 120 mg per dL (4.4 to 6.7 mmol per L). New oral medications make these targets easier to achieve, especially in patients with recently diagnosed diabetes. Acarbose, metformin, miglitol, pioglitazone, rosiglitazone and troglitazone help the patient's own insulin control glucose levels and allow early treatment with little risk of hypoglycemia. Two new long-acting sulfonylureas (glimepiride and extended-release glipizide) and a short-acting sulfonylurea-like agent (repaglinide) simply and reliably augment the patient's insulin supply. Combinations of agents have additive therapeutic effects and can restore glucose control when a single agent is no longer successful. Oral therapy for early type 2 diabetes can be relatively inexpensive, and evidence of its cost-effectiveness is accumulating.
Riddle
M C
MC
Oregon Health Sciences University School of Medicine, Portland 97210, USA.
D017485:1-Deoxynojirimycin / Q000031:analogs & derivatives; D020909:Acarbose / Q000627:therapeutic use; D000284:Administration, Oral; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005944:Glucosamine / Q000031:analogs & derivatives / Q000627:therapeutic use; D065089:Glycoside Hydrolase Inhibitors; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics; D050112:Imino Pyranoses; D008687:Metformin / Q000627:therapeutic use; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use; D045162:Thiazolidinediones; D014481:United States
D001786:Blood Glucose; D004791:Enzyme Inhibitors; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D050112:Imino Pyranoses; D013453:Sulfonylurea Compounds; D013844:Thiazoles; D045162:Thiazolidinediones; C045621:miglitol; D017485:1-Deoxynojirimycin; D008687:Metformin; C089946:2,4-thiazolidinedione; D005944:Glucosamine; D020909:Acarbose