Reappraisal of the pharmacologic approach to treatment of type 2 diabetes mellitus.
Nearly 16 million adults in the United States have diabetes mellitus, and the incidence of type 2 diabetes, the most prevalent form of diabetes, has steadily increased during the past decade. Patients with diabetes are at increased risk for microvascular and macrovascular complications and experience significant morbidity and mortality. Diabetes is the leading cause of blindness, end-stage renal disease, and nontraumatic amputations in adults. Because diabetes is a progressive disorder, the importance of early and appropriate treatment cannot be overemphasized. Present therapeutic strategies for the management of type 2 diabetes are adequate but are not maximally effective. Clearly, reappraisal of the pharmacologic approach to the optimal management of patients with type 2 diabetes is needed. A number of oral hypoglycemic agents, including thiazolidinediones, biguanides, sulfonylureas, and alpha-glucosidase inhibitors, may be used to normalize glucose levels in patients with type 2 diabetes. Because insulin resistance is an underlying pathologic defect in patients with type 2 diabetes, agents that increase insulin sensitivity should be used early in the course of therapy. By using a multifaceted approach to target insulin resistance, many patients with type 2 diabetes may achieve normoglycemia and improved long-term outcomes.
Weissman
Peter
P
Departments of Medicine and Endocrinology, University of Miami School of Medicine, 8940 N Kendall Drive, Suite 804E, Miami, FL 33176, USA. peternweissman@worldnet.att.net
D000284:Administration, Oral; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001645:Biguanides / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology; D005944:Glucosamine / Q000031:analogs & derivatives; D020249:Hormone Replacement Therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007333:Insulin Resistance; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D001645:Biguanides; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D013844:Thiazoles; D005944:Glucosamine