title: Optimizing management of glycaemia.
abstract: The global epidemic of type 2 diabetes (T2DM) continues largely unabated due to an increasingly sedentary lifestyle and obesogenic environment. A cost-effective patient-centred approach, incorporating glucose-lowering therapy and modification of cardiovascular risk factors, could help prevent the inevitable development and progression of macrovascular and microvascular complications. Glycaemic optimization requires patient structured education, self-management and empowerment, and psychological support along with early and proactive use of glucose lowering therapies, which should be delivered in a system of care as shown by the Chronic Care Model. From diagnosis, intensive glycaemic control and individualised care is aimed at reducing complications. In older people, the goal is maintaining quality of life and minimizing morbidity, especially as overtreatment increases hypoglycaemia risk. Maintaining durable glycaemic control is challenging and complex to achieve without hypoglycaemia, weight gain and other significant adverse effects. Overcoming patient and physician barriers can help ensure adequate treatment initiation and intensification. Cardiovascular safety studies with newer glucose-lowering agents are now mandatory, with a sodium glucose co-transporter-2 inhibitor (empagliflozin), and two glucagon like peptide-1 receptor agonists (liraglutide and semaglutide) being the first to demonstrate superior CV outcomes compared with placebo.
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; Diabetes Research Centre, College of Medicine, Biological Sciences & Psychology, University of Leicester, The Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. Electronic address: Sudesna.Chatterjee@uhl-tr.nhs.uk.
authors.forename: Sudesna
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; Diabetes Research Centre, College of Medicine, Biological Sciences & Psychology, University of Leicester, The Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; Diabetes Research Centre, College of Medicine, Biological Sciences & Psychology, University of Leicester, The Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Davies
mesh_terms: D066126:Cardiotoxicity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D019468:Disease Management; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D007004:Hypoglycemic Agents
keywords: SGLT2 inhibitors; T2DM; glucose-lowering therapies; hypoglycaemia; incretin therapies; insulin