Optimizing management of glycaemia

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• 作者：Dr Sudesna Chatterjee ; MD FRCP^a ; ^b ; ^{Sudesna.Chatterjee@uhl-tr.nhs.uk" class="auth_mail" title="E-mail the corresponding author} (Senior Clinical Researcher ; Honorary Consultant in Diabetes ; Endocrinology) ; Prof Kamlesh Khunti ; PhD MD FRCGP FRCP^a ; ^b (Professor of Primary Care Diabetes ; Vascular Medicine ; NIHR Senior Investigator) ; Prof Melanie J. Davies ; MB ChB MD FRCP FRCGP^a ; ^b (Professor of Diabetes Medicine ; NIHR Senior Investigator)
• 关键词：T2DM ; glucose-lowering therapies ; hypoglycaemia ; incretin therapies ; SGLT2 inhibitors ; insulin
• 刊名：Best Practice Research Clinical Endocrinology Metabolism
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：30
• 期：3
• 页码：397-411
• 全文大小：1074 K

文摘

The global epidemic of type 2 diabetes (T2DM) continues largely unabated due to an increasingly sedentary lifestyle and obesogenic environment. A cost-effective patient-centred approach, incorporating glucose-lowering therapy and modification of cardiovascular risk factors, could help prevent the inevitable development and progression of macrovascular and microvascular complications. Glycaemic optimization requires patient structured education, self-management and empowerment, and psychological support along with early and proactive use of glucose lowering therapies, which should be delivered in a system of care as shown by the Chronic Care Model. From diagnosis, intensive glycaemic control and individualised care is aimed at reducing complications. In older people, the goal is maintaining quality of life and minimizing morbidity, especially as overtreatment increases hypoglycaemia risk. Maintaining durable glycaemic control is challenging and complex to achieve without hypoglycaemia, weight gain and other significant adverse effects. Overcoming patient and physician barriers can help ensure adequate treatment initiation and intensification. Cardiovascular safety studies with newer glucose-lowering agents are now mandatory, with a sodium glucose co-transporter-2 inhibitor (empagliflozin), and two glucagon like peptide-1 receptor agonists (liraglutide and semaglutide) being the first to demonstrate superior CV outcomes compared with placebo.