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gwt-tud.de
Type 2 Diabetes is characterized by a deficit in early insulin secretion and increased insulin resistance. Based on the measurement of fasting and 2 h postprandial blood glucose a simple typing of hyperglycemia is possible in isolated fasting hyperglycemia (IFH), isolated postprandial hyperglycemia (IPH) and combined hyperglycemia (CH). IFH is predominantly associated with insulin resistance whereas in IPH a more pronounced insulin deficit is found. This and other simple parameters such as BMI, comorbidities and age are the basis of differential therapy with OAD if best efforts with life style modification fail to reach the target values of the lipid triad. Patients with IFH profit particularly from metformin and long acting sulfonylureas (glimepiride, glibenclamide). Patients with IPH are candidates for prandial antidiabetics (AGI, nateglinide, repaglinide). Antihyperglycemic agents such as metformin and AGI bear no risk of hyperglycemia and reduce body weight. Prandial insulin secretagogues have lower risk of weight gain and hypoglycemia than long acting sulfonylureas. They are therefore beneficial in obese patients and the elderly. The same principles are valid for combination treatment. With exception of insulin secretagogues all OAD can be combined if monotherapy fails to reach the target levels of the gluco-triad. Instead of a stepwise treatment algorithm an individualized therapy based on pathophysiology and comorbidities taking into account the global risk seems to be beneficial.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12235731&dopt=Abstract
Diabete Metab. 1991 May;17(1 Pt 2):191-6.
Management of type 2 diabetes mellitus with special reference to metformin therapy.
Campbell IW.
Diabetic Department, Victoria Hospital, Kirkcaldy, Fife, Scotland, U.K.
As monotherapy, metformin is similar to the sulphonylureas, in improving both fasting and post-prandial plasma glucose levels by approx. 25-30%. Metformin, unlike the sulphonylureas, does not promote insulin secretion and does not cause weight gain and is therefore preferable in obese NIDDM. Metformin is also of benefit as combined therapy with a sulphonylurea, and in older subjects the two drugs may give as good glycaemic control as insulin. Lactic acidosis with metformin is less common than sulphonylurea-induced hypoglycaemia although the mortality risk is similar. However, where both groups of drugs are properly used clinically, serious side-effects are unusual. Metformin may have a potential advantage in the management of NIDDM with hyperinsulinaemia in that it does not increase insulin levels. Where insulin levels have been compared in the same type II patients, metformin can achieve similar glycaemic control as a sulphonylurea (gliclazide) but with significantly lower plasma insulin levels.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1936475&dopt=Abstract
smamif.org
Our study of patients with type 2 diabetes mellitus residing in the Paris area (Ile-de-France) aged 70 years or younger included 1 591 patients examined by national health insurance expert physicians who also filled out a self-administrated questionnaire. Their primary care physicians also answered a questionnaire (79% participation, indicating their personal implication). We found that diabetes was most often discovered during regular check-ups. Single-drug regimens were the most widely used. Sulfamides were prescribed for 77% of the patients. Among the 912 patients who were overweight (BMI > 28 Kg/m2), 34.3% were taking sulfamides alone despite the fact that metformin is recommended as the first intention drug for these patients. Blood pressure control was not satisfactory in 30% of the patients who were treated or not for high blood pressure. This proportion rose to about 50% among treated patients alone. The patients appeared to be knowledgeable about the risk of complications, particularly ocular complications. They were aware of a certain number of messages but the results would suggest difficulty in application.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11011242&dopt=Abstract
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