What are the guidelines for the management of blood glucose in Type 2 Diabetes Mellitus?

From: American Family Physician

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Participants/situation

  • The paper is a review of the existing evidence

Study

  • The paper is a systematic review / meta analysis of all relevant trials.
  • This means that the data from all similar trials has been grouped to form an overall outcome.

Results

  • Evidence-based guidelines for the treatment of type 2 diabetes mellitus focus on three areas: intensive lifestyle intervention that includes at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet; aggressive management of cardiovascular risk factors (i.e., hypertension, dyslipidemia, and microalbuminuria) with the use of aspirin, statins, and angiotensin-converting enzyme inhibitors; and normalisation of blood glucose levels (hemoglobin A1C level less than 7 percent).
  • Patients with impaired glucose tolerance should be provided with counselling and instruction for weight loss and physical activity.
  • Metformin (Glucophage) is the only medication proven to reduce mortality rates in patients with type 2 diabetes.
  • Acarbose (Precose) seems to reduce the risk of cardiovascular disease events.
  • Other medications include sulfonylureas and nonsulfonylurea secretagogues, alpha glucosidase inhibitors, and thiazolidinediones. Insulin can be used acutely in patients newly diagnosed with type 2 diabetes to normalise blood glucose, or it can be added to a regimen of oral medication to improve glycemic control. 

Answer

  • 150 minutes per week of physical activity.
  • Weight loss with an initial goal of 7 percent of baseline weight,
  • Low-fat, reduced-calorie diet.
  • Counselling and instruction for weight loss and physical activity.

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