title: Consulting on the patient with type 2 diabetes: matching medication to disease mechanism.
abstract: Type 2 diabetes places a significant burden on the health care system today and its incidence is expected to increase at an alarming rate over the next 20 years. Type 2 diabetes is associated with increasing insulin resistance and beta-cell dysfunction, and with macro- and microvascular complications (including cardiovascular disease, retinopathy, peripheral neuropathy, and end-stage renal disease). The primary rationale for intensive management of type 2 diabetes is to reduce or prevent microvascular and cardiovascular events; therefore, treatment goals encompass glycemic, blood pressure, and lipid targets. Thiazolidinediones (TZDs) improve insulin sensitivity and preserve beta-cell function, and clinical evidence supports the early use of these agents in preventing the progression of diabetes in high-risk patients. The durability of glycemic control with monotherapy varies among orally available antidiabetic agents, and, inevitably, patients with type 2 diabetes will require a combination of antidiabetic agents to reach glycemic goals. Fixed-dose combination therapy is associated with increased adherence to the treatment regimen and improved outcomes. Intensive management of patients with type 2 diabetes has been shown to decrease the rate of complications and reduce health care costs.
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000378:metabolism / Q000494:pharmacology*; D012017:Referral and Consultation; D014481:United States
chemical_list: D007004:Hypoglycemic Agents