January 10th, 2018
Treatment and management of type 2 diabetes Mellitus
Treatment and Management of T2DM
Treatment of T2DM is aimed at stabilizing the symptoms and minimizing the risk of developing diabetic complications (Strayer & Schub, 2011). Treatment involves administration of antidiabetic drugs and/or insulin or insulin analogues to lower the blood glucose concentrations (Strayer & Schub, 2011). The first-line antidiabetic medication is metformin, which reduces hepatic glucose production and enhances the sensitivity of cells to insulin (van Raalte & Diamant, 2011; Zinman, 2011). Administration of exogenous insulin or insulin analogues is also aimed at reducing hyperglycemia, but the initiation and intensification of such therapy is challenged by the high likelihood for patients developing hypoglycemia following insulin administration (Tibaldi, 2008). Accordingly, insulin therapy is accompanied by oral administration of glucose whenever symptoms of hypoglycemia arise (Strayer & Schub, 2011). Insulin therapy thus requires appropriate patient education to enable them recognize and deal with the risk of hypoglycemia posed by such therapy (Tibaldi, 2008).
Additionally, treatment of T2DM involves the monitoring and treatment of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic non-ketotic syndrome (HHNS) (Strayer & Schub, 2011; Campbell, 2011). Such treatment involves correcting electrolyte loss, acidosis, dehydration and nutritional imbalance, failure of which leads to coma and death (Strayer & Schub, 2011). Apart from treatment, preventative approaches such as increasing physical activity and a dietary regimen that reduces the risk of obesity could avert the development of T2DM (Schub & Caple, 2011; Zinman, 2011).
T2DM presents a significant challenge to the health care systems due to its high prevalence and association with an increased risk of morbidity and mortality. The condition is characterized by a reduced sensitivity to insulin with progressive impairment of insulin production by β-pancreatic cells. Although there is a delayed manifestation of symptoms in T2DM, subsequently symptoms such as polyuria, polydipsia, constant hunger and fatigue manifest. Diagnosis of T2DM is based on plasma glucose concentration, either by measuring the fasting glucose levels or 2-hour postprandial plasma glucose concentrations. T2DM affects other body processes such as initiation of lipid oxidation in the liver and promoting hepatic (liver) glucose production. Treatment approaches seek to lower blood glucose concentration by administering antidiabetic medications and exogenous insulin, while avoiding the development of hypoglycemia. Preventative approaches stress the role of physical activity and diet in addressing risk factors such as obesity. Untreated T2DM could result into complications such as nephropathy and retinopathy and eventually to death.
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