title: The treatment of type 2 diabetes.
abstract: BACKGROUND
  5% to 8% of adults have type 2 diabetes, a disease that is usually asymptomatic at first. The goals of management are timely diagnosis and the prevention of complications.
  
  
  METHODS
  Selective review of the literature, including guidelines from Germany and abroad.
  
  
  RESULTS
  High caloric intake and lack of exercise are the main contributing causes of type 2 diabetes and the principal targets of intervention. If lifestyle changes do not yield adequate improvement, then drug treatment should be initiated (or intensified) and managed on the basis of the HbA1c fraction. Guidelines recommend an HbA1c target range of 6.5% to 7.5%; the individual target value should be chosen in consideration of patient-specific factors and established in collaboration with the patient. Metformin is recommended for initial drug treatment. If metformin is contraindicated, poorly tolerated, or inadequately effective, many therapeutic alternatives and supplements are available. Clinical trials have shown that sulfonylureas and insulin are beneficial with respect to patient-relevant endpoints, but comparable data from clinical trials are not yet available for any other antidiabetic drug (except metformin). For individual patients, other drugs may have advantages such as a lower risk of hypoglycemia, less weight gain, oral administration, and/or applicability in the setting of renal insufficiency. The treatment is individually oriented, depending on the patient's age, disease stage, body weight, comorbidities, work situation, adherence, and personal priorities. Combining more than two antidiabetic drugs is not recommended.
  
  
  CONCLUSIONS
  Although there are many treatment options, individualized long-term treatment still presents a challenge in many cases.
authors.affiliation: German Institute of Human Nutrition (DIfE) Potsdam-Rehbrücke, Nuthetal, Department of Endocrinology and Metabolic Diseases, Charité Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Medical Clinic I (General Internal Medicine, Endocrinology and Diabetology, Gastroenterology and Hepatology), Berufsgenossenschaftliches Universitäts - klinikum Bergmannsheil, Klinikum der Ruhr- Universität Bochum.
authors.forename: Andreas F H
authors.initials: AF
authors.lastname: Pfeiffer
authors.forename: Harald H
authors.initials: HH
authors.lastname: Klein
mesh_terms: D031204:Caloric Restriction / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000628:therapy*; D050528:Diet, Carbohydrate-Restricted / Q000379:methods*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents