Materiały źródłowe

• #1 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction, through control of glycemia. […] Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with expertise in diabetes, working in collaboration with the patient and family. Management includes the following: Appropriate goal setting, Dietary and exercise modifications, Medications, Appropriate self-monitoring of blood glucose (SMBG), Regular monitoring for complications, Laboratory assessment.

• #2 Patient education: Type 2 diabetes: Treatment (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/type-2-diabetes-treatment-beyond-the-basics

  Patient education: Type 2 diabetes: Treatment (Beyond the Basics) […] People with type 2 diabetes require regular monitoring and ongoing treatment to maintain blood sugar levels at goal. Treatment includes lifestyle changes (including dietary changes and exercise to promote weight loss), self-care measures, and often medications, which can minimize the risk of diabetes-related and cardiovascular (heart-related) complications. […] The main goals of treatment in type 2 diabetes are to keep your blood sugar levels within your goal range and treat other medical conditions that go along with diabetes (like high blood pressure and high cholesterol); it is also very important to stop smoking if you smoke. These measures will reduce your risk of complications. […] Blood sugar management — It is important to keep your blood sugar levels at goal. This can help prevent long-term complications that can result from poorly managed blood sugar (including problems affecting the eyes, kidneys, nervous system, and cardiovascular system).

• #3 Patient education: Type 2 diabetes: Treatment (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/type-2-diabetes-treatment-beyond-the-basics

  A1C testing — Blood sugar management can also be estimated with a blood test called glycated hemoglobin, or „A1C.” The A1C blood test measures your average blood sugar level over the past two to three months. The goal A1C for most young people with type 2 diabetes is less than 7 percent (53 mmol/mol), which corresponds to an average blood sugar of approximately 150 mg/dL (8.3 mmol/L) (table 1). Lowering your A1C level reduces your risk for kidney, eye, and nerve problems. […] A number of medications are available to treat type 2 diabetes. […] Metformin — Most people who are newly diagnosed with type 2 diabetes will immediately begin a medicine called metformin. Metformin improves your body’s response to insulin and, as a result, lowers blood sugar levels. […] Your doctor or nurse might recommend a second medication in addition to metformin. This may happen within the first two to three months if your blood sugar and A1C levels are still higher than your goal; otherwise, many people need to add a second glucose-lowering medication later (after several years of having diabetes).

• #4 Patient education: Type 2 diabetes: Treatment (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/type-2-diabetes-treatment-beyond-the-basics/print

  A1C testing — Blood sugar management can also be estimated with a blood test called glycated hemoglobin, or „A1C.” The A1C blood test measures your average blood sugar level over the past two to three months. The goal A1C for most young people with type 2 diabetes is less than 7 percent (53 mmol/mol), which corresponds to an average blood sugar of approximately 150 mg/dL (8.3 mmol/L) (table 1). Lowering your A1C level reduces your risk for kidney, eye, and nerve problems. […] A detailed discussion of ways to prevent complications is available separately. […] Diet and exercise are the foundation of diabetes management. […] Regular exercise can also help manage type 2 diabetes, even if you do not lose weight. Exercise lowers blood sugar because it improves your body’s response to insulin.

• #5 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  The ACP said that this higher target is aimed at helping patients benefit from glycemic control while avoiding the adverse effects associated with low blood sugar, medication burden, and costs of stricter targets. […] In a 2021 joint consensus statement from the ADA, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK, the term remission, as it applies to type 2 diabetes, is defined as the presence of an HbA1c level below 6.5% (48 mmol/mol) at least 3 months after glucose-lowering pharmacotherapy has been halted. […] Early initiation of pharmacologic therapy is associated with improved glycemic control and reduced long-term complications in type 2 diabetes. […] Drug classes used for the treatment of type 2 diabetes include the following: Biguanides, Sulfonylureas, Meglitinide derivatives, Alpha-glucosidase inhibitors, Thiazolidinediones (TZDs), Glucagonlike peptide1 (GLP-1) agonists, GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonists, Dipeptidyl peptidase IV (DPP-4) inhibitors, Selective sodium-glucose transporter2 (SGLT-2) inhibitors, Nonsteroidal mineralocorticoid receptor (MR) antagonists, Insulins, Amylinomimetics, Bile acid sequestrants, Dopamine agonists.

• #6 Type 2 Diabetes: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21501-type-2-diabetes

  Type 2 diabetes happens when your body cant use insulin properly. Without treatment, Type 2 diabetes can cause various health problems, like heart disease, kidney disease and stroke. You can manage this disease by making lifestyle changes, taking medications and seeing your healthcare provider for regular check-ins. […] The core features of Type 2 diabetes management include: Lifestyle changes, like more exercise and eating adjustments. Blood sugar monitoring. Medication. […] Your healthcare provider may recommend taking medication, in addition to lifestyle changes, to manage Type 2 diabetes. These include: Oral diabetes medications: These are medications that you take by mouth to help manage blood sugar levels in people who have T2D but still produce some insulin. […] Type 2 diabetes is a chronic (long-term) disease, which means you must manage it for the rest of your life. Theres no cure for T2D. But you can manage it with lifestyle changes, medication and blood sugar monitoring in a way that keeps your blood sugar levels in a healthy range.

• #7 Type 2 Diabetes – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513253/

  Type 2 diabetes mellitus (T2DM) accounts for around 90% of all cases of diabetes. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM. T2DM is most commonly seen in persons older than 45 years. Still, it is increasingly seen in children, adolescents, and younger adults due to rising levels of obesity, physical inactivity, and energy-dense diets. […] For both T1DM and T2DM, the cornerstone of therapy is diet and exercise. A diet low in saturated fat, refined carbohydrates, high fructose corn syrup, and high in fiber and monounsaturated fats needs to be encouraged. Aerobic exercise for a duration of 90 to 150 minutes per week is also beneficial. The major target in T2DM patients, who are obese, is weight loss.

• #8 Type 2 Diabetes: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/diabetes/type-2-diabetes

  Managing type 2 diabetes includes a mix of lifestyle changes and medication. […] You may be able to reach your target blood sugar levels with diet and exercise alone. […] Weight loss can seem overwhelming, but portion control and eating healthy foods are a good place to start. […] A registered dietitian can teach you about carbs and help you make a meal plan you can stick with. […] Try to get 30-60 minutes of physical activity every day. […] Depending on your treatment, especially if you’re on insulin, your doctor will tell you if you need to test your blood sugar levels and how often to do it. […] If lifestyle changes don’t get you to your target blood sugar levels, you may need medication. […] Metformin is usually the first medication used to treat type 2 diabetes. […] If you take more than one drug to control your type 2 diabetes, that’s called combination therapy. […] Weight loss surgery can effectively treat type 2 diabetes by helping you lose weight. […] Always talk to your doctor before trying any alternative treatment. These treatments can’t replace diabetes medications.

• #9 Diabetes: What It Is, Causes, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/7104-diabetes

  Physical activity increases insulin sensitivity (and helps reduce insulin resistance), so regular exercise is an important part of management for all people with diabetes. […] Studies show that people with diabetes may be able to reduce their risk of complications by consistently keeping their A1c levels below 7%.

• #10 Advances in the management of type 2 diabetes in adults | BMJ Medicine

  https://bmjmedicine.bmj.com/content/2/1/e000372

  The primary objectives of the management of diabetes are to reduce the incidence and burden of complications and to improve quality of life. Historically, these objectives were pursued through control of hyperglycaemia. […] Over the past decade, multiple randomised controlled trials have shown a reduction in cardiovascular disease, kidney disease, heart failure, and mortality with the use of glucagon-like peptide 1 receptor agonists (GLP1RAs) and sodium glucose cotransporter 2 inhibitors (SGLT2is), independent of a reduction in levels of HbA1c. […] This pathogenesis centric approach places the management of obesity at the centre of the prevention and treatment of the disease. […] Even a relatively small amount (5-7%) of weight loss reduced the risk of incident diabetes and improved glycaemic control in people with type 2 diabetes.

• #11 Type 2 diabetes treatments | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/type-2-diabetes/treatments

  We know people with type 2 diabetes who are living with overweight or obesity can manage their blood sugar levels effectively and quickly by losing weight following a very low-calorie diet. […] We know people can put their type 2 diabetes into remission by losing weight. It can be life-changing, but it’s not possible for everyone. And it is not a cure.

• #12 Type 2 Diabetes Therapies: A STEPS Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0215/p237.html

  Major guidelines are increasingly aligned with a STEPS approach to pharmacotherapy for type 2 diabetes. Although it has traditionally focused on disease-oriented outcomes, the American Diabetes Association was more patient-oriented in 2018, strongly recommending metformin as first-line therapy, with additional agents added after consideration of hypoglycemia risk, comorbidities, potential adverse effects, effectiveness, price, and delivery method.

• #12 Type 2 Diabetes Therapies: A STEPS Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0215/p237.html

  Several recent large randomized controlled trials have significantly improved physicians’ knowledge about the impact of medications for type 2 diabetes mellitus on patient-oriented outcomes. A concise and organized way to evaluate pharmacotherapy options is to use the five patient-oriented STEPS criteria: safety, tolerability, effectiveness, price, and simplicity. The first-line treatment option, metformin, is safe and fairly well-tolerated, has excellent long-term effectiveness on patient-oriented outcomes, is moderately priced, and has a simple dosing regimen. However, most patients with type 2 diabetes require more than one medication. The STEPS approach can help choose subsequent medications if metformin does not provide adequate glycemic control. […] The American Diabetes Association recommends the biguanide metformin (Glucophage) as first-line pharmacotherapy for type 2 diabetes. The STEPS criteria show why: it is safe and fairly well-tolerated, has excellent long-term effectiveness on patient-oriented outcomes, is moderately priced, and has a simple dosing regimen. No other diabetes medication excels in the STEPS criteria as well as metformin. However, most patients with type 2 diabetes require more than one medication. The STEPS approach can help us choose subsequent medications if metformin does not provide adequate glycemic control for our patients.

• #13 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  Metformin is the only biguanide in clinical use. […] Metformin has proved effective and safe. […] Metformin lowers basal and postprandial plasma glucose levels. […] Patients on metformin have shown significant improvements in hemoglobin A1c and their lipid profile, especially when baseline values are abnormally elevated. […] In January 2017, the American College of Physicians (ACP) released a guideline update recommending the use of metformin as a first-line treatment for type 2 diabetes. […] A study by Vashisht et al that examined data from more than 246.5 million patients found that when used along with metformin therapy for type 2 diabetes, treatment with sulfonylureas, DPP-4 inhibitors, or thiazolidinediones was equally effective in reducing the HbA1c level to 7% or below that of total hemoglobin.

• #14 Type 2 diabetes: Which medication is best for me? – Harvard Health

  https://www.health.harvard.edu/blog/type-2-diabetes-which-medication-is-best-for-me-2020110521256

  If you are living with type 2 diabetes, you certainly are not alone. One in 10 people in the US has diabetes, according to the CDC. However, despite considerable progress in diabetes treatment over the past 20 years, fewer than half of those with diabetes actually reach their target blood sugar goal. […] One reason for this may be the overwhelming number of medications currently available. And yet, waiting too long to adjust treatment for type 2 diabetes can have long-lasting negative effects on the body that may raise the risk of heart and kidney disease and other complications. […] This is why losing 5% to 10% of ones baseline weight by healthful eating and physical activity remains the backbone of type 2 diabetes management. […] Metformin is a tried and tested medicine that has been used for many decades to treat type 2 diabetes, and is recommended by most experts as first-line therapy. It is affordable, safe, effective, and well tolerated by most people.

• #15 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  Sulfonylureas and insulin therapy do not increase macrovascular disease risk. […] Metformin reduces macrovascular risk in patients with obesity. […] Vigorous blood pressure control reduces microvascular and macrovascular events; beta blockers and angiotensin-converting enzyme (ACE) inhibitors appear to be equally effective in this regard. […] GLP-1 agonists (ie, exenatide, liraglutide, albiglutide [discontinued], dulaglutide) mimic the endogenous incretin GLP-1; they stimulate glucose-dependent insulin release, reduce glucagon, and slow gastric emptying. […] The use of a GLP-1 in addition to metformin and/or a sulfonylurea may result in modest weight loss. […] The addition of exenatide in patients receiving insulin glargine as basal insulin helps to improve glycemic control without the risk of increased hypoglycemia or weight gain.

• #16 List of Common Diabetes Medications

  https://www.healthline.com/health/diabetes/medications-list

  Some people with type 2 diabetes may also need to take insulin. The same types of insulin used to treat type 1 diabetes can also treat type 2 diabetes. […] A doctor may recommend the aforementioned types of insulin used in type 1 diabetes treatment for type 2 diabetes. […] These medications help your body break down starchy foods and table sugar. This effect lowers your blood sugar levels. […] Biguanides decrease how much glucose your liver makes. They also decrease how much glucose your intestines absorb, help your muscles absorb glucose, and make your body more sensitive to insulin. […] The most common biguanide is metformin (Glumetza, Riomet, Riomet ER). […] Metformin is considered the most commonly prescribed oral medication for type 2 diabetes. It can also be combined with other type 2 diabetes medications.

• #17 Type 2 Diabetes Treatment and Management | Doctor

  https://patient.info/doctor/management-of-type-2-diabetes

  For adults on a drug associated with hypoglycaemia, support the person to aim for an HbA1c level of 53 mmol/mol (7.0%). […] Offer standard-release metformin as the initial drug treatment for adults with type 2 diabetes. […] If an adult with type 2 diabetes experiences gastrointestinal side-effects with standard-release metformin, consider a trial of modified-release metformin. […] In adults with type 2 diabetes, if metformin is contra-indicated or not tolerated, assess the cardiovascular risk using a recognised risk scoring system such as QRISK3. […] If they have chronic heart failure or established atherosclerotic cardiovascular disease, offer an SGLT2 inhibitor with proven cardiovascular benefit in addition to metformin. […] For adults with type 2 diabetes, if monotherapy has not continued to control HbA1c to below the person’s individually agreed threshold for further intervention, consider adding: A DPP4 inhibitor; or Pioglitazone; or A sulfonylurea; or An SGLT2 inhibitor for people who meet the criteria in NICE’s technology appraisal guidance on canagliflozin in combination therapy.

• #18 Patient education: Type 2 diabetes: Treatment (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/type-2-diabetes-treatment-beyond-the-basics/print

  A number of medications are available to treat type 2 diabetes. […] Metformin — Most people who are newly diagnosed with type 2 diabetes will immediately begin a medicine called metformin. Metformin improves your body’s response to insulin and, as a result, lowers blood sugar levels. […] Your doctor or nurse might recommend a second medication in addition to metformin. This may happen within the first two to three months if your blood sugar and A1C levels are still higher than your goal; otherwise, many people need to add a second glucose-lowering medication later (after several years of having diabetes). […] Insulin — In the past, insulin treatment was reserved for patients with type 2 diabetes whose blood sugar was not adequately managed with oral medicines and lifestyle changes (ie, diet and exercise). However, increasing evidence suggests that insulin treatment at earlier stages may improve overall diabetes management over time. […] More detailed information about insulin treatment is available separately.

• #19 Type 2 diabetes: Medications

  https://www.diabinfo.de/en/living-with-diabetes/type-2-diabetes/treatment/medications.html

  Metformin is a biguanide that continues to be recommended in the type 2 diabetes guidelines as a first-choice drug for cases with no increased risk of cardiovascular disease. […] The available endpoint studies point to metformin reducing the incidence of diabetes-associated cardiovascular disease as well as overall mortality rates (according to studies with limited evidence). […] Glitazones (e.g., thiazolidinediones such as pioglitazone) improve the insulin sensitivity of fatty tissue, the liver, and muscles. and correspondingly glucose uptake, while reducing both the fasting and post-meal blood sugar levels. […] Sulfonylureas work by stimulating the release of insulin from the pancreas. […] All previous endpoint studies state that sulfonylureas can prevent diabetes-induced complications affecting the eyes (retinopathy), kidneys (nephropathy), nerves (neuropathy), and feet (diabetic foot syndrome) (according to studies with limited evidence).

• #20 Type 2 diabetes: Which medication is best for me? – Harvard Health

  https://www.health.harvard.edu/blog/type-2-diabetes-which-medication-is-best-for-me-2020110521256

  GLP-1 receptor agonists are drugs that lower blood sugar after eating by helping your bodys insulin work more efficiently. […] SGLT2 inhibitors like empagliflozin (Jardiance), canagliflozin (Invokana), dapagliflozin (Farxiga), and ertugliflozin (Steglatro) are also a newer class of medications that work by blocking your kidneys from reabsorbing sugar back into your body. […] While these diabetes medications certainly have more to offer than just improvements in blood sugar, they remain costly and inaccessible to many individuals. This is why it is essential to have an open and honest conversation with your doctor about what is most important to you and what aligns with your goals and preferences. Management of a complex disease like diabetes takes an entire team, with you being the key team member.

• #21 Type 2 diabetes: Medications

  https://www.diabinfo.de/en/living-with-diabetes/type-2-diabetes/treatment/medications.html

  DPP-4 (dipeptidyl peptidase-4) inhibitors (gliptins) inhibit the DPP-4 enzyme in the blood. […] SGLT-2 (sodium dependent glucose co-transporter 2) inhibitors (glifozines) reduce blood sugar levels by blocking the SGLT-2 enzyme in the kidney. […] GLP-1 receptor agonists (glutides) simulate the effects of the gastrointestinal hormone GLP-1. They also cause an early onset of the sensation of being full and result in weight loss. […] Current endpoint studies show that some GLP-1 receptor agonists also reduce the risk of cardiovascular and kidney disease (nephropathy) as well as reducing the premature mortality rate especially in persons with preexisting heart disease (moderate to high evidence level).

• #22 What Are My Options for Type 2 Diabetes Medications? | ADA

  https://diabetes.org/health-wellness/medication/oral-other-injectable-diabetes-medications

  There are different types, or classes, of medications that work in different ways to lower blood glucose levels. Some options are taken by mouth and others are injected. […] Metformin lowers blood glucose levels primarily by decreasing the amount of glucose produced by the liver. […] DPP-4 inhibitors help improve A1C (a measure of average blood glucose levels over two to three months) without causing hypoglycemia (low blood glucose). […] Use of GLP-1 and dual GLP-1/GIP receptor agonists is another strategy to help use these hormones to improve blood glucose management in people with type 2 diabetes. […] By increasing the amount of glucose excreted in the urine, people can see improved blood glucose, some weight loss, and small decreases in blood pressure. […] Sulfonylureas have been in use since the 1950s and they stimulate beta cells in the pancreas to release more insulin.

• #23 What Are My Options for Type 2 Diabetes Medications? | ADA

  https://diabetes.org/health-wellness/medication/oral-other-injectable-diabetes-medications

  Rosiglitazone (Avandia) and pioglitazone (Actos) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and reduce glucose production in the liver. […] In addition to the commonly used classes discussed above, there are other less commonly used medications that can work well for some people. […] Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together to help meet your individualized diabetes goals. […] Insulin may also be used to treat type 2 diabetes.

• #24 List of Common Diabetes Medications

  https://www.healthline.com/health/diabetes/medications-list

  GLP-1 receptor agonists are similar to incretin. A doctor may prescribe them in addition to a diet and exercise plan to help promote better glycemic control. […] For some people, atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease may predominate over their diabetes. In these cases, the American Diabetes Association (ADA) recommends certain GLP-1 receptor agonists as part of a glucose-lowering treatment regimen. […] SGLT2 inhibitors work by preventing the kidneys from holding on to glucose. Instead, your body gets rid of the glucose through your urine. […] Again, in cases where atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease predominate, the ADA recommends SGLT2 inhibitors as a possible treatment option. […] These are among the oldest diabetes drugs still used today. They work by stimulating the pancreas with the help of beta cells. This causes your body to make more insulin. […] Thiazolidinediones work by decreasing glucose in your liver. They also help your fat cells use insulin better by targeting insulin resistance.

• #25 The future of diabetes treatment: Is a cure possible?

  https://www.labiotech.eu/in-depth/diabetes-treatment-cure-review/

  One of the biggest shifts in type 2 diabetes treatment has been the emergence of glucagon-like peptide 1 (GLP-1) receptor agonists, which stimulate insulin production in pancreatic beta cells and suppress glucagon secretion. […] A newer generation of combination therapies is pushing these benefits even further. Tirzepatide (Mounjaro), approved in 2022, merges the actions of GLP-1 and gastric inhibitory polypeptide (GIP) in a single molecule. This dual action helps lower glucose levels, reduce appetite, and trigger fat loss. […] Drug delivery is also evolving. While GLP-1s have traditionally required injections, oral formulations are on the horizon. Orforglipron, an oral GLP-1 receptor agonist from Eli Lilly, showed promising phase 3 results in 2025 and could soon offer a needle-free option for patients, helping improve long-term adherence.

• #26 Advances in the management of type 2 diabetes in adults | BMJ Medicine

  https://bmjmedicine.bmj.com/content/2/1/e000372

  Weight loss is greatest with the dual glucose dependent insulinotropic polypeptide (GIP)-GLP1RA, tirzepatide, and subcutaneous semaglutide, followed by dulaglutide and liraglutide. […] Efforts to lose weight in people with type 2 diabetes and obesity should be supported through preferential use of glucose lowering drugs that are associated with weight loss, avoiding glucose lowering and non-diabetes drugs associated with weight gain, and aiming for weight loss of 12-15% as appropriate, to achieve maximum benefits.

• #27 Medication Treatment of Diabetes Mellitus – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/diabetes-mellitus-dm-and-disorders-of-blood-sugar-metabolism/medication-treatment-of-diabetes-mellitus

  Injectable antihyperglycemic medications are given together with other antihyperglycemic medications. […] GLP-1 medications are given by injection. The most common side effects are nausea and vomiting. […] Pramlintide is currently the only available amylin-like medication. It suppresses secretion of the hormone glucagon. Because glucagon increases blood glucose, pramlintide thus helps lower blood glucose. It also slows the passage of food out of the stomach and helps people feel full. It is given by injection and is used in combination with mealtime insulin in people with type 1 or type 2 diabetes.

• #28 Combination therapy for type 2 diabetes

  https://www.medicalnewstoday.com/articles/combination-therapy-type-2-diabetes

  Doctors may prescribe combination therapy to people with type 2 diabetes who have high blood glucose levels despite relying on treatment with metformin or another medication. […] People with type 2 diabetes who are at higher risk of experiencing diabetes-related complications will receive combination therapy even if their blood glucose levels are within target range. […] The American Diabetes Association (ADA) recommends combination therapy with a glucagon-like-peptide-1 receptor agonist (GLP-1 RA) or sodium-glucose transport protein 2 (SGLT2) inhibitor for people with these conditions. […] Combination therapy usually uses metformin with one or more of the following medications: […] Combination therapy can help lower blood sugar levels and keep them within target range. This in turn lowers the risk of diabetes-related complications.

• #29 How to: Rescue therapy in the management of type 2 diabetes – DiabetesontheNet

  https://diabetesonthenet.com/diabetes-primary-care/how-to-rescue-therapy/

  If there is little or no response to sulfonylurea therapy, this could suggest insulin deficiency and insulin therapy may be required. […] Insulin is the preferred therapy in certain circumstances, specifically if severe hyperglycaemia is present (HbA1c 86 mmol/mol [10.0%]), and especially if associated with weight loss or ketonuria/ketosis, in underweight people or if type 1 diabetes is suspected. […] Where the diabetes diagnosis is unclear and/or type 1 diabetes is suspected, insulin should not be delayed whilst awaiting specialist review or diabetes autoantibody testing and should be started pre-emptively. […] NICE recommends people with an HbA1c 75 mmol/mol (9.0%) to start a pre-mixed (biphasic) insulin, although in clinical practice basal insulin is often the initial insulin utilised in many people with type 2 diabetes requiring rescue therapy.

• #30 How to: Rescue therapy in the management of type 2 diabetes – DiabetesontheNet

  https://diabetesonthenet.com/diabetes-primary-care/how-to-rescue-therapy/

  NICE guidance refers to rescue therapy as either insulin-based treatment and/or sulfonylurea therapy. In people with type 2 diabetes, it recommends the use of rescue therapy at any phase of treatment if there is symptomatic hyperglycaemia, and reviewing treatment when blood glucose control has been achieved. […] Temporary insulin therapy may also be required in people with type 2 diabetes during periods of acute illness and admission to hospital, and in those on steroid therapy or chemotherapy, when marked hyperglycaemia is not sufficiently managed with oral or non-insulin injectable glucose-lowering therapies. […] Commonly used sulfonylureas are gliclazide and glimepiride. Their glucose-lowering effect is usually seen within a few days of initiation provided there is adequate pancreatic beta-cell function. An HbA1c reduction of 1122 mmol/mol (1.02.0%) can be expected, when added to lifestyle measures.

• #31 Insulin for type 2 diabetes – NHS

  https://www.nhs.uk/medicines/insulin/insulin-for-type-2-diabetes/

  Insulin is a medicine that helps your body use glucose (sugar) for energy. […] You’ll need to be prescribed insulin for type 2 diabetes if other diabetes medicines no longer work well enough to keep your blood glucose within a healthy range. […] Insulin reduces the chances of getting the symptoms of high blood glucose (hyperglycaemia) and serious long-term problems that can damage your heart, kidneys, eyes and nerves. […] People who need insulin for type 2 diabetes usually take either: a long-acting or intermediate-acting insulin once or twice a day, a long-acting or intermediate-acting insulin once or twice a day, and a separate rapid-acting or short-acting insulin before meals, or a mixed insulin (biphasic insulin), containing both intermediate and rapid-acting or short-acting insulin, 1 to 3 times a day before meals.

• #32 Insulin for type 2 diabetes – NHS

  https://www.nhs.uk/medicines/insulin/insulin-for-type-2-diabetes/

  Your doctor or diabetes care team will discuss your treatment with you and recommend the insulin treatment they think is best for you. The type of insulin you take and your dose may change over time. […] Your doctor or care team will usually recommend intermediate-acting insulin (brand names Humulin I or Insulatard). This type of insulin is taken once or twice a day. […] They may recommend a type of long-acting insulin (brand names Levemir, Lantus, Toujeo, Tresiba, Semglee or Abasaglar) if you either: often get low blood sugar (hypoglycaemia, or hypos) or need help from a carer to take injections. […] If a long-acting or intermediate-acting insulin does not lower your blood glucose enough on its own, you’ll also need to take another type of insulin that works more quickly. […] If you need both intermediate and rapid-acting insulin, your doctor or care team might recommend a mixed insulin instead of separate injections.

• #33

  https://bpac.org.nz/2021/diabetes-management.aspx

  Most patients are initiated on once-daily basal insulin, injected at night; isophane insulin (an intermediate-acting insulin) is an appropriate choice for most patients. […] Metformin is usually continued when insulin is started as it can result in less weight gain and lower doses of insulin being required to meet HbA1c targets. […] Empagliflozin is usually continued when insulin is initiated; combining SGLT-2 inhibitor and insulin treatment can result in less weight gain and greater reduction in HbA1c levels without increasing the risk of hypoglycaemia. […] Dulaglutide is usually continued when insulin is initiated; combining GLP-1 receptor agonist and insulin treatment can result in less weight gain and greater reduction in HbA1c levels without increasing the risk of hypoglycaemia.

• #34 Overview | Type 2 diabetes in adults: management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng28

  This guideline covers care and management for adults (aged 18 and over) with type 2 diabetes. It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications. […] This guideline includes recommendations on: individualised care, managing blood glucose levels, including HbA1c measurement and targets, first-line drug treatment, reviewing drug treatments, treatment options if further interventions are needed, antiplatelet therapy, managing complications. […] The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

• #35 Advances in the management of type 2 diabetes in adults | BMJ Medicine

  https://bmjmedicine.bmj.com/content/2/1/e000372

  In people with established atherosclerotic cardiovascular disease or risk factors for atherosclerotic cardiovascular disease, a GLP1RA or SGLT2i with known cardiovascular benefit should be started, regardless of levels of HbA1c or background glucose lowering treatments. […] GLP1RAs have shown benefit for secondary kidney related outcomes in large individual randomised controlled trials and meta-analyses of cardiovascular outcomes, but dedicated kidney outcome trials are ongoing. […] Therefore, SGLT2is with primary evidence are preferred for individuals with an estimated glomerular filtration rate 60mL/min/1.73 m2 or albuminuria, or both, to reduce the progression of chronic kidney disease. […] Current guidelines from the American Diabetes Association/European Association for the Study of Diabetes no longer recommend metformin as the preferred first line agent for all individuals with type 2 diabetes, and instead suggest consideration of cardiac and kidney comorbidities when selecting first line treatment.

• #36 Surgery for Diabetes – American Society for Metabolic and Bariatric Surgery

  https://asmbs.org/patients/surgery-for-diabetes/

  Obesity and type 2 diabetes (adult-onset diabetes) are closely related conditions, both linked to problems with the body’s metabolism. The same changes that lead to weight loss after surgery can also lead to the remission of type 2 diabetes. Most importantly, patients with this disease should know that the body’s ability to use sugar in a healthy way can be regained with surgery. […] Diabetes surgery is the most effective treatment for type 2 diabetes and may result in remission (being able to stop taking all medications) or improvement in nearly all cases. […] For patients with type 2 diabetes and even milder degrees of obesity, bariatric surgery should be recommended. It is the single most effective way to resolve the condition and stop the need for medication. […] If you are living with diabetes, you should know that one of the most important discoveries in the management of diabetes is that surgery can help control or improve type 2 diabetes in the large majority of patients.

• #37 Surgery for Diabetes – American Society for Metabolic and Bariatric Surgery

  https://asmbs.org/patients/surgery-for-diabetes/

  Nearly all individuals who have surgery to treat diabetes (also called metabolic/bariatric surgery) show improvement in their diabetes, sometimes as quickly as a few days after surgery. They experience lower blood sugar levels, need less diabetes medications, and see an improvement in diabetes-related health problems. Overall, 78 percent of patients experience remission thus eliminating the need for diabetes medications. […] Diabetes surgery has been proven to be the most effective therapy for diabetes but also greatly improves obesity and other associated conditions. […] A great deal of scientific evidence supports the use of diabetes surgery in patients with BMI of 30 and greater. If you have type 2 diabetes and a BMI of 30 and above, you may qualify for diabetes treatment through surgery.

• #38 Surgery for Diabetes – American Society for Metabolic and Bariatric Surgery

  https://asmbs.org/patients/surgery-for-diabetes/

  Improvement of diabetes after gastric bypass surgery occurs within days to weeks after surgery, even before much weight is lost. Most importantly, this surgery results in changes to the metabolism and hormones produced in the intestines that affect the body’s ability to achieve and maintain a healthy weight. […] Over 60 percent of patients will have remission of their type 2 diabetes after sleeve gastrectomy. […] Studies find, however, that the operation is most effective in inducing early and sustained remission or improvement of T2DM (more than 85 percent remission rates with weight-loss independent effects). […] Results for this operation are extremely promising, demonstrating excellent weight loss and type 2 diabetes remission. […] While diabetes surgery has some risk, these operations have been fine-tuned over the past 70 years and are now among the safest commonly performed operations. The long-term risk of continued diabetes (as well as the risks of obesity) is far greater than the risk of a surgical procedure for most patients.

• #39 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20241014/Promising-new-treatment-strategy-for-type-2-diabetes.aspx

  Groundbreaking research presented at UEG Week 2024 reveals a promising new treatment strategy for type 2 diabetes (T2D) that could significantly reduce or even eliminate the need for insulin therapy. […] This innovative approach, which combines a novel procedure known as ReCET (Re-Cellularization via Electroporation Therapy) with semaglutide, resulted in the elimination of insulin therapy for 86% of patients. […] Remarkably, at the 6- and 12-month follow-up, 86% of participants (12 out of 14) no longer required insulin therapy, and this success continued through the 24-month follow-up. […] These findings are very encouraging, suggesting that ReCET is a safe and feasible procedure that, when combined with semaglutide, can effectively eliminate the need for insulin therapy. […] Busch further added, „Unlike drug therapy, which requires daily medication adherence, ReCET is compliance-free, addressing the critical issue of ongoing patient adherence in the management of T2D. In addition, the treatment is disease-modifying: it improves the patient’s sensitivity to their own (endogenous) insulin, tackling the root cause of the disease, as opposed to currently available drug therapies, that are at best disease-controlling.”

• #40 New type 2 diabetes treatment could mean an end to insulin shots

  https://newatlas.com/diabetes/recet-semaglutide-type-2-diabetes/

  86% of type 2 diabetes patients treated with a new procedure no longer needed insulin throughout the two-year-long study they participated in. […] In this new study, Dr. Busch carried out a procedure called Recellularization via Electroporation Therapy, or ReCET. […] Following the endoscopic procedure, the participants followed a strict isocaloric liquid diet for two weeks. They then began a course of weekly semaglutide medication; it’s prescribed for treating type 2 diabetics by controlling blood sugar. […] At the 6- and 12-month follow-ups, 12 out of 14 participants no longer required insulin therapy. They didn’t need it at the 24-month mark either. […] Dr. Busch noted that these results suggested „ReCET is a safe and feasible procedure that, when combined with semaglutide, can effectively eliminate the need for insulin therapy.”

• #41 New Treatment for Type 2 Diabetes on the Horizon

  https://www.orlandohealth.com/content-hub/new-treatment-for-type-2-diabetes-on-the-horizon/

  Depending on the severity, Type 2 diabetes can affect your life in small or major ways. Modern medicine offers a variety of routes to keeping blood sugar at a healthy level. […] If approved by the FDA, the outpatient medical procedure duodenal mucosal resurfacing, or DMR, is likely to become another option for treating Type 2 diabetes. […] So far, clinical trials show that DMR will lead to your Type 2 diabetes being under control for at least a year, maybe two, until your mucosa grows back. Glucose levels will drop to healthier rates, and a blood marker called H1C will drop by 1.5 to 1.8, the same amount as with effective medications. […] Youll simply have less severe Type 2 diabetes or none at all. Youll be able to reduce or eliminate your blood sugar drugs. […] Better yet, it doesnt only control damage from Type 2 diabetes. It might even help identify the root cause. If that happens, duodenal mucosal resurfacing will be revolutionary.

• #42 The future of diabetes treatment: Is a cure possible?

  https://www.labiotech.eu/in-depth/diabetes-treatment-cure-review/

  Recent studies have explored interventions aimed at modulating the gut microbiota to improve glycemic control. […] Pendulum Therapeutics has developed Pendulum Glucose Control, a medical probiotic containing strains like Akkermansia muciniphila and Clostridium butyricum. Clinical studies have demonstrated that this formulation can reduce hemoglobin A1c levels by 0.6% and decrease postprandial glucose spikes by 33% in individuals with type 2 diabetes. […] More recently, Valbiotis TOTUM-63, a plant-based polyphenol-rich extract, has shown promise in managing early-stage type 2 diabetes. […] While these advancements are encouraging, the complexity of the gut microbiome and its interactions with host metabolism necessitate further investigation. Establishing causality and understanding the mechanisms underlying these interventions will be crucial for integrating microbiome-targeted therapies into standard type 2 diabetes management protocols.

• #43 Type 2 diabetes treatment transformed by new precision medicine – UKRI

  https://www.ukri.org/news/type-2-diabetes-treatment-transformed-by-new-precision-medicine/

  Millions of people with type 2 diabetes could get better treatment thanks to a new, simple low-cost tool that predicts the most effective drug for an individual. […] The study, published in the Lancet, has developed an innovative way of identifying the most effective glucose-lowering drugs for a person with type 2 diabetes. […] The new tool was created to tackle the challenge of which drug to choose after metformin. […] The research revealed that only 18% of people with type 2 diabetes in the UK have been treated with the most effective glucose-lowering drug for them. […] Importantly, these improvements in blood glucose levels could approximately double the time until people need to start taking further diabetes medications. […] Using routinely collected clinical information, the tool offers a low-cost, practical, immediately usable solution that could transform the treatment of type 2 diabetes.

• #44 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  Review of blood glucose logs must be part of any diabetes management plan. […] With each health-care system encounter, patients with diabetes should be educated about and encouraged to follow an appropriate treatment plan. Adherence to diet and exercise should continue to be stressed throughout treatment, because these lifestyle measures can have a large effect on the degree of diabetic control that patients can achieve. […] A study by Morrison et al found that more frequent visits with a primary care provider (every 2 wk) led to markedly rapid reductions in serum glucose, HbA1c, and low-density lipoprotein (LDL) cholesterol levels. […] According to a 2018 guidance statement by the American College of Physicians (ACP), Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.

• #45 Manage Type 2 Diabetes With the Help of These 10 People

  https://www.everydayhealth.com/type-2-diabetes/treatment/creating-your-care-team/

  A large part of diabetes management is good nutrition, according to the American Diabetes Association. This means knowing what to eat and avoid and how to fit in the foods you love while keeping your blood sugar in check. […] A CDCES usually has a lot more time to spend with the person with diabetes than a PCP does. Appointments with a CDCES are typically up to an hour, Bereolos explains. This really allows for more personalized care so that you can succeed in reaching your goals. […] Care of teeth and gums is vital for everyone, but it’s especially important if you have type 2 diabetes. According to the National Institute of Diabetes and Digestive and Kidney Diseases, people with diabetes are at increased risk of developing cavities, gum disease, and other oral health problems. […] Seeing a podiatrist to monitor and treat foot problems decreases the risk of amputation by as much as 85 percent, the organization says.

• #46 Coping With a Type 2 Diabetes Diagnosis | Diabetes | CDC

  https://www.cdc.gov/diabetes/signs-symptoms/coping-with-type-2-diagnosis.html

  A diabetes care and education specialist will be an important part of your health care team. These licensed health care professionals will work with you to develop a personalized management plan. Your plan will be specific to your health needs, lifestyle, beliefs, and culture. […] DSMES has been proven to help improve A1C, blood pressure, and cholesterol levels. What’s more, it can even help reduce the risk of diabetes complications and hospitalizations. Ask your doctor for a referral to DSMES to help you manage your diabetes. […] Eating healthy foods lower in carbohydrates, added sugars, saturated fat, and sodium (salt) will be key to managing your blood sugar. […] One of the best ways to manage diabetes is to get regular physical activity. […] Regular physical activity has many other health benefits as well, like better sleep, weight loss, and less stress. It can also improve your blood pressure and cholesterol levels. […] With the right diabetes management plan, you’ll be able to live your best life while successfully managing your diabetes.

• #47 Advances in the management of type 2 diabetes in adults | BMJ Medicine

  https://bmjmedicine.bmj.com/content/2/1/e000372

  Type 2 diabetes is a chronic and progressive cardiometabolic disorder that affects more than 10% of adults worldwide and is a major cause of morbidity, mortality, disability, and high costs. Over the past decade, the pattern of management of diabetes has shifted from a predominantly glucose centric approach, focused on lowering levels of haemoglobin A1c (HbA1c), to a directed complications centric approach, aimed at preventing short term and long term complications of diabetes, and a pathogenesis centric approach, which looks at the underlying metabolic dysfunction of excess adiposity that both causes and complicates the management of diabetes. […] In this review, we discuss the latest advances in patient centred care for type 2 diabetes, focusing on drug and non-drug approaches to reducing the risks of complications of diabetes in adults.

• #48 Coping With a Type 2 Diabetes Diagnosis | Diabetes | CDC

  https://www.cdc.gov/diabetes/signs-symptoms/coping-with-type-2-diagnosis.html

  While there’s no cure for type 2 diabetes, there are ways to manage it and thrive. There’s also no one-size-fits-all diabetes management and treatment plan. Your doctor, diabetes education specialist, and other health care professionals can help you create a plan for your specific needs. […] A successful diabetes management plan will include healthy eating, exercise, medical support, and emotional support. Getting emotional support is just as important as any other part of diabetes care and treatment. […] People with diabetes are living longer, healthier lives than ever before with fewer complications. And help is available through diabetes self-management education and support (DSMES) services. With DSMES, you can gain the knowledge, skills, and support needed to successfully manage diabetes.

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