Management of glycemia in type 2 diabetes

The management of type 2 diabetes has been revolutionized over the last 3 to 5 years as a result of dramatic changes in our health care system, new clinical trial data, novel pharmacologic agents, and a better understanding of appropriate methods for patient education regarding lifestyle issues. As a result, diabetes management has become much more heterogeneous, with dramatic differences in style and approach used by practitioners, whether diabetes specialists, primary care providers, or allied health professionals. Diabetes care has also become much more rewarding: The vast majority of patients can now achieve excellent glycemic control while leading full and unrestricted lives. In this article, a construct is reviewed by which comprehensive diabetes care may be approached in a primary care setting. The overall goal of diabetes management should be to provide an opportunity for patients to live out their normal life expectancies with minimal complications. In other articles, screening and treatment suggestions for diabetes complications are provided. Prospective interventional and epidemiologic studies demonstrate that glycemic control is critical to avoidance of complications; the methods to achieve glycemic control are the major focus of this chapter.