Standards of Treatment for Diabetes – 2018
Another year is here, and for several common disease states, that means the yearly review and revision of treatment recommendations. Each December, the American Diabetes Association publishes an annual revision of their standards for treatment of diabetes.
Diabetes is a metabolic condition in which blood glucose is elevated because the body either does not produce insulin or does not respond appropriately to insulin that is produced and secreted by the pancreas. Insulin helps glucose enter cells so that it can serve as an energy source for the body. Without the effect of insulin, blood sugar is elevated while cells may be starving for energy.
There are two basic types of diabetes:
- type 1 diabetes usually develops in younger patients when the pancreas stops producing insulin;
- type 2 diabetes usually develops in overweight and older patients when the pancreas cannot secrete enough insulin to meet the needs of the body, sometimes because cells fail to respond normally to insulin.
- Patients may also have elevated blood glucose because of pregnancy, stress or because they are taking certain medicines.
While patients with type 1 diabetes often present with symptoms (excessive thirst, frequent urination and hunger), type 2 diabetes is often present without any noticeable symptoms. Screening for diabetes is recommended for patients who are overweight and have at least one risk factor (like hypertension, high cholesterol, or a close relative with diabetes), pregnant patients, and every three years for all patients beginning at age 45. There is an increased emphasis on testing adolescents and children who are overweight or obese and at risk for type 2 diabetes.
Insulin injections remain the mainstay for treatment of type 1 diabetes. For type 2 diabetes, current recommendations include:
- all patient should receive metformin if it is tolerated unless there is some contraindication;
- when additional medication is required along with metformin, it should be chosen to help other risk factors (such as cardiovascular or renal) in addition to treating high blood glucose;
- lifestyle modifications, particularly exercise, remain an important part of diabetes treatment;
- medications that improve blood glucose and promote weight loss remain on the list of preferred drugs; these include the GLP-1 receptor agonists that help the body respond better to insulin, and the SGLT2 inhibitors, drugs that promote the excretion of glucose in the urine;
- basal and/or mealtime insulin injections remain an effective treatment for type 2 diabetes, particularly when oral medications cannot control blood glucose levels.
Diabetes is a common condition that can be well-controlled with medications and insulin. Maintaining control of blood glucose in patients minimizes the development of illness classically associated with diabetes: poor circulation, loss of vision, increased cardiovascular complications and loss of kidney function. When blood glucose is controlled, diabetic patients live long healthy lives.
That’s another good reason to get tested for diabetes if you are at risk and to talk with your prescriber or pharmacist about your diabetes medications. Your pharmacist can help you optimize your drug treatment, monitor your therapy and answer any questions you might have. When diabetes is controlled, diabetic patients live longer. Take care of yourself.
ADA Standards of Medical Care in Diabetes-2018