Patient management strategies in type 2 diabetes: current practices and future considerations

To examine current issues in the management of people with type 2 diabetes, focusing on the need for early recognition, aggressive multifactorial therapy, and a systems approach to treatment in order to reduce the development and progression of the serious and costly complications of this disease.

Affecting more than 6% of the population in the United States, type 2 diabetes and its complications have become a serious public health concern that exerts a substantial toll on the individuals affected, the entire health care system, and the economy, including employers. Clinical data suggest that early intervention can diminish the risk for developing diabetes in high-risk individuals with prediabetes. Further, improved glycemic control in individuals with diabetes substantially lowers the risk for microvascular complications, and evidence is increasing that it can also decrease macrovascular complications. To maintain long-term glycemic control and reductions in diabetes-related complications, people with diabetes require lifestyle measures, and many will also require combinations of antidiabetic medications and, often, additional treatments for coexisting hypertension and dyslipidemia. Unfortunately, the majority of individuals with type 2 diabetes have not achieved the optimal glucose, blood pressure, or lipid levels recommended by national guidelines. A more aggressive multifactorial approach to treatment is required to improve treatment outcomes for the increasing numbers of people with type 2 diabetes. The comprehensive team approach needed should include early recognition of at-risk individuals, use of risk-specific therapies, regular patient education, and consistent follow-up.

Despite a prevalence that has reached epidemic proportions, type 2 diabetes remains underdiagnosed and suboptimally controlled. A more aggressive multifactorial approach to treatment is required to improve treatment outcomes.