[National practice guidelines. New aspects in therapy of type 2 diabetes mellitus]

Sequelae of type 2 diabetes can often be prevented by applying rigorous countermeasures. To optimize this approach, guidelines have been established. The first measure should be to teach the diabetic how to change his/her life-style (more exercise, changes in diet). If this does not succeed in achieving the target HbA1c of 6.5%, oral treatment should be initiated. The choice of antidiabetic is determined largely by the BMI, but other factors such as lifestyle, age, and concomitant diseases should also be taken into account. Unfortunately, monotherapy often becomes ineffective within a few years, so that combination treatment has to be initiated. If this also fails to accomplish optimal control, individualized insulin treatment should be started. A simple start is continuation of the oral treatment in conjunction with a bedtime oral insulin. Also available are prandial, conventional and flexibly intensified insulin therapy. During insulin therapy, treatment of the insulin resistance with an oral antidiabetic, mostly metformin, and the lifestyle changes must be continued.