Defining the importance of daily glycemic control and implications for type 2 diabetes management.
Glycemic control remains an elusive goal for most patients with type 2 diabetes. Questions concerning glucose targets that have emerged from recent outcomes studies further complicate glucose control strategies. Navigating through these challenges requires an understanding of the relationship between hyperglycemia, glycemic variability, and risk, as well as how to combine antidiabetic agents safely and effectively to minimize complications. Relevant data were selected from recently published major outcomes studies and peer-reviewed articles discussing glycemic variability, incretins, and dipeptidyl peptidase-4 inhibition. Incretin hormones play a premier role in maintaining normal glucose homeostasis. In type 2 diabetes, however, incretin functioning is impaired and glucose homeostasis is disturbed, contributing to hyperglycemia and both acute and chronic glucose fluctuations. Glycemic control efforts should involve quarterly glycated hemoglobin assessments, routine monitoring of daily blood glucose values, and combination therapy that targets both fasting and postprandial hyperglycemia. Dipeptidyl peptidase-4 inhibitors, which enhance endogenous incretin function, are well suited for combination with other agents to promote daily glycemic control without increasing the risk of hypoglycemia or weight gain. Results of recent outcomes studies suggest that a lifetime strategy for diabetes management might involve aggressive efforts to control glycemia daily and early in type 2 diabetes, with less stringent glucose targets and avoidance of hypoglycemia as patients acquire comorbidities, such as advanced cardiovascular disease. Dipeptidyl peptidase-4 inhibitors have the potential to play a vital role in diabetes management at all stages of the disease.
Bode
Bruce W
BW
Atlanta Diabetes Associates, Atlanta, GA 30309, USA. bbode001@aol.com
D000218:Adamantane / Q000031:analogs & derivatives / Q000627:therapeutic use; D015190:Blood Glucose Self-Monitoring; D002940:Circadian Rhythm; D017281:Cost of Illness; D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism*; D004151:Dipeptides / Q000627:therapeutic use; D018819:Dipeptidyl Peptidase 4; D054873:Dipeptidyl-Peptidase IV Inhibitors; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006442:Glycated Hemoglobin / Q000032:analysis; D038321:Glycemic Index; D006801:Humans; D054795:Incretins / Q000378:metabolism; D011719:Pyrazines / Q000627:therapeutic use; D000068900:Sitagliptin Phosphate; D017211:Treatment Failure; D014230:Triazoles / Q000627:therapeutic use
D000218:Adamantane; D004151:Dipeptides; D018819:Dipeptidyl Peptidase 4; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D054795:Incretins; D011719:Pyrazines; D000068900:Sitagliptin Phosphate; D014230:Triazoles; C517652:hemoglobin A1c protein, human; C502994:saxagliptin; C042807:DPP4 protein, human