Abstract

Treatment of patients with type 2 diabetes mellitus includes education, evaluation for micro- and macrovascular complications, attempts to achieve near normoglycemia, minimization of cardiovascular and other long-term risk factors, and avoidance of drugs that can exacerbate abnormalities of insulin or lipid metabolism. All of these treatments need to be tempered based on individual factors, such as age, life expectancy, and comorbidities. Although studies of bariatric surgery and aggressive insulin therapy have noted remissions of type 2 diabetes mellitus that may last several years, the large majority of patients require continuous treatment in order to maintain target glycemia. Treatments to achieve reductions in hyperglycemia focus on increasing insulin availability (either through direct insulin administration or through agents that promote insulin secretion), improving sensitivity to insulin, delaying the delivery and absorption of carbohydrate from the gastrointestinal tract, increasing urinary glucose excretion, or a combination of these approaches. Methods used to control blood glucose in patients with newly diagnosed type 2 diabetes are reviewed here. Further management of persistent hyperglycemia and other therapeutic issues, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately.