Overview of Type 2 Diabetes Treatments
Type 2 diabetes treatments are used to lower blood glucose. The goal is to attain and maintain an acceptable range to reduce symptoms and the risk for complications. Your physician may prescribe one treatment or a combination.
Treatment tools include diet and exercise, self-monitoring, oral medications, injected medications, insulin pumps, continuous glucose monitoring, and more. Not all are part of usual diabetes care. Your doctor will tailor a custom regimen using one or more of these tools.
Diet and Exercise
Diet and exercise can be used alone or to increase the effectiveness of medications.
Diet can be an exchange diet, carbohydrate counting, or other diet plan you and your doctor or qualified dietary professional agree upon. Meal planning is vital if using insulin or another medication that increases the risk of hypoglycemia. Bariatric surgery has been used as a type 2 diabetes treatment for patients who are severely obese and have hard-to-control glucose levels.
Exercise not only promotes weight loss and decreases the risk for complications, but it can also help improve insulin sensitivity and lipid profiles.
More About Diet and Exercise
Meal Plans for Diabetes Management
Can Bariatric Surgery Make Type 2 Diabetes Disappear
Exercising When You Have Diabetes
Glucose Monitoring: A small sample of blood is used with a glucometer to measure blood glucose levels. Your doctor may ask you to check your levels occasionally or three or more times per day depending on your needs and goals.
Logging: Fasting and after-meal glucose levels can be recorded in a log book, application, program, or website.
A1c Testing: This lab test (also known has HbA1c) is used not only to diagnose diabetes, but also to see the average blood sugar levels over the past 2-3 months.
Oral medications can be used alone or in combination with other oral or injected medications. Here is a list of the most common oral drugs used in Type 2 diabetes treatment arranged by drug classification:
Biguanides: Most commonly prescribed drugs for Type 2 diabetes. They reduce the amount of glucose released by the liver and increase insulin sensitivity.
Includes: Glucophage (metformin) and Glucophage XR (metformin extended release)
Sulfonylureas: The oldest class of Type 2 oral medication. They increase the amount of insulin produced by the pancreas.
Includes: Tolinase (tolzamide), Glucotrol (glipizide), Glucotrol XL (glipizide extended release), Amaryl (glimepride), Diabeta (glyburide) and Micronase (glyburide)
Alpha Glucosidase Inhibitors: These are essentially medicines that block the breakdown of starches and slow digestion.
Includes: Glyset (miglitol) and Precose (acarbose)
Thiazolidinediones: These drugs increase insulin sensitivity and lower glucose production.
Includes: Actos (pioglitazone) and Avandia (rosiglitazone)
Note: In 2007, the Food and Drug Administration (FDA) issued a safety alert regarding Avandia and the possibility of increased risk of heart attacks or other cardiovascular events. Rezulin (troglitazone), another drug in this class, was withdrawn from the U.S. Market in 2000 due to adverse liver effects.
Meglitinides: These drugs increase the amount of insulin produced by the pancreas.
Includes: Prandin (repaglinide) and Starlix (nateglinide)
DPP-4 Inhibitors: A newer class of drug that lowers glucose by blocking an enzyme.
Includes: Januvia (sitagliptin phosphate)
Note: In 2009, the FDA expanded the warnings for this drug, adding information about reported cases of acute pancreatitis and the need for careful monitoring.
Insulin: Insulin injection can be a Type 2 diabetes treatment option if control cannot be attained with other treatments or in special circumstances, like pregnancy. Insulin can be short-acting, long-acting or a mixture and can be injected via syringe, insulin pen or an insulin pump.
Byetta: A newer injected medication that increases the amount of insulin produced by the pancreas and slows digestion. It is injected using a pre-filled pen.
Symlin: Another newer injected medication delivered via a pre-filled pen. Symlin is used along with insulin. It is the synthetic version of a human hormone called amylin and helps control after-meal blood glucose levels.
Insulin Pumps and Continuous Glucose Monitoring
Insulin pumps are gadgets that deliver small amounts of insulin throughout the day as well as instant doses to cover meals. It can be carried in a pocket or clipped onto clothing. It is connected to the body via a small needle that stays inserted under the skin.
Continuous glucose monitoring (CGM) systems record and sometimes display blood glucose levels over time. This can be helpful for those with hypoglycemia and/or hypoglycemia unawareness. These systems are not common and are usually not covered by health insurance.
Self-Management, Healthcare Team and Support
Important yet often overlooked as diabetes treatment tools are self-management education, establishing a diabetes healthcare team, and on-going support.
American Diabetes Association. " Standards of Medical Care in Diabetes - 2010." Diabetes Care January 2010 33:S11-S61
Fowler MD, Michael J. "Diabetes Treatment, Part 1: Diet and Exercise." Clinical Diabetes July 2007 25(3):105-109
Hoogwerf, BJ. "Exenatide and pramlintide: new glucose-lowering agents for treating diabetes mellitus." Cleveland Clinic Journal of Medicine 2006 73:477-484
National Diabetes Information Clearinghouse. What I need to Know about Diabetes. Accessed: May 23, 2010 http://diabetes.niddk.nih.gov/dm/pubs/medicines_ez/
Pratley MD, Richard E; Salsali, Afshin. "Inhibition of DPP-4: a new therapeutic approach for the treatment of type 2 diabetes." Current Medical Research and Opinion 2007 23:919-931