How can we implement current therapies and interventions to achieve glycemic control?
OBJECTIVE
To discuss the appropriate use of oral therapies to achieve and sustain glycemic targets in patients with type 2 diabetes.


METHODS
The stages in the development and progression of type 2 diabetes are reviewed, and the limitations of single-drug therapy are addressed.


RESULTS
The development of diabetes is a staged progression; affected patients show evolution through numerous stages of glucose intolerance before clinical diabetes manifests. Beta cell function continues to deteriorate until absolute failure occurs; however, other factors, such as glucose and lipid toxicities, insulin resistance in peripheral tissues, and loss of the first-phase insulin response, further impair the body's ability to regulate release of insulin in response to glucose. Traditional treatment algorithms often fail to address the progressive, multifaceted nature of type 2 diabetes, with its numerous related abnormalities. Combination therapy with orally administered agents can be used to manage glucose concentrations and other risk factors safely and effectively.


CONCLUSIONS
The therapeutic goal in type 2 diabetes is to achieve and maintain a physiologic profile as close to normal as possible. This outcome necessitates treatment of multiple defects with use of various combinations of orally administered agents. Clinicians should focus on effective treatment of these defects to achieve established targets.
Gavin
James R
JR
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005215:Fasting; D005951:Glucose Tolerance Test; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D011446:Prospective Studies; D006113:United Kingdom
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin