title: Partnering with patients to improve therapeutic outcomes: incretin-based therapy for type 2 diabetes.
abstract: The prevalence of type 2 diabetes mellitus has reached epidemic proportions. Current treatment options for patients with diabetes include lifestyle modifications (eg, diet and exercise) along with pharmacotherapy (eg, oral antidiabetic drugs [OADs], incretin-based therapies, and insulin). Despite the availability of effective and safe treatments, many patients do not achieve recommended glycemic targets, thereby increasing their risk of long-term complications. Given the progressive nature of diabetes and the need for extensive patient management, it is important that physicians and patients develop a partnership to achieve therapeutic goals. At diagnosis, the diabetes care team, led by the patient, should evaluate all aspects of management, including appropriate treatment options that are suited to the patient's quality of life, convenience, and therapeutic goals. Treatment should also consider the patient's comorbidities, including hypertension and obesity. Management of early type 2 diabetes should include OADs and incretin-based therapies, and preference should be given to agents that do not cause either hypoglycemia or weight gain. A basal insulin should be initiated if glycemic control is not achieved with >or= 1 agents or if presenting glucose control is poor. Irrespective of pharmacotherapy, all patients should be encouraged to maintain a healthy diet and exercise regimen. Patients also need to become active participants in disease management by monitoring blood glucose, complying with medication, adhering to lifestyle modifications, and setting weight loss goals when appropriate. This article emphasizes the need for physicians and other health care providers to partner with patients to achieve therapeutic goals and presents a novel, multifaceted approach toward improving the management of diabetes in a clinical practice setting.
authors.affiliation: HealthReach Diabetes Endocrine, Nutrition Center, Hampton, NH 03842, USA. dnadeaumd@gmail.com
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Nadeau
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D018819:Dipeptidyl Peptidase 4 / Q000502:physiology; D054873:Dipeptidyl-Peptidase IV Inhibitors; D000067757:Glucagon-Like Peptide-1 Receptor; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D054795:Incretins / Q000502:physiology*; D007328:Insulin / Q000627:therapeutic use; D055118:Medication Adherence; D009765:Obesity / Q000209:etiology / Q000517:prevention & control; D010817:Physician-Patient Relations; D018027:Receptors, Glucagon / Q000819:agonists* / Q000502:physiology; D040242:Risk Reduction Behavior; D015431:Weight Loss
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; C000593833:GLP1R protein, human; D000067757:Glucagon-Like Peptide-1 Receptor; D007004:Hypoglycemic Agents; D054795:Incretins; D007328:Insulin; D018027:Receptors, Glucagon; C042807:DPP4 protein, human; D018819:Dipeptidyl Peptidase 4