Determining the most appropriate treatment for patients with non-insulin-dependent diabetes mellitus

Today it is possible, with the available treatment armamentarium, for a physician to rationally choose a strategy to be customized to patients with type II diabetes. The keystone of treatment is a good nutritional plan that provides for proper nutrition as well as appropriate weight loss. Exercise is also a useful adjunct. When diet therapy is unsuccessful, the use of oral sulfonylureas may be indicated. These agents have been shown to stimulate insulin release, to reduce hepatic glucose output, to potentiate insulin action in a postreceptor mechanism, and to have a modest effect in increasing insulin receptors. The first-generation compounds have a 70% success rate within the first 5 years after initiating therapy. However, these agents can have undesirable side effects. The second-generation agents, such as glipizide, offer the advantages of high efficacy, inactive metabolites, nonionic binding, and low reported alcohol flushing. Many patients who fail on first-generation agents may respond to second-generation drugs. Insulin therapy can be used if the patient fails on an oral agent.