Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes

The prevalence of type 2 diabetes continues to increase at an alarming rate around the world, with even more people being affected by prediabetes Although the pathogenesis and long term complications of type 2 diabetes are fairly well known its treatment has remained challenging with only half of the patients achieving the recommended hemoglobin A(1c) target This narrative review explores the pathogenetic rationale for the treatment of type 2 diabetes with the view of fostering better understanding of the evolving treatment modalities The diagnostic criteria including the role of hemoglobin A(1c) in the diagnosis of diabetes are discussed Due attention is given to the different therapeutic maneuvers and their utility in the management of the diabetic patient The evidence supporting the role of exercise, medical nutrition therapy glucose monitoring and antiobesity measures including pharmacotherapy and bariatric surgery is discussed The controversial subject of optimum glycemic control in hospitalized and ambulatory patients is discussed in detail An update of the available pharmacologic options for the management of type 2 diabetes is provided with particular emphasis on newer and emerging modalities Special attention has been given to the initiation of insulin therapy in patients with type 2 diabetes with explanation of the pathophysiologic basis for insulin therapy in the ambulatory diabetic patient A review of the evidence supporting the efficacy of the different preventive measures is also provided (C) 2011 Published by Elsevier Inc