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  • Title: [Current issues in the therapy of diabetes mellitus].
    Author: Halmos T.
    Journal: Orv Hetil; 2004 Nov 21; 145(47):2363-70. PubMed ID: 15641668.
    Abstract:
    Up-to-date therapy and patient care in diabetes started with reliable measuring of endogenous insulin in blood. In the past decades, extensive epidemiologic studies proved, that long lasting normoglycemia inhibits the development of chronic diabetic complications. It became also clear, that continuous normotension, and normal lipid values have equal protective effect. These new findings were in strong correlation with the adoption of the concept of the Metabolic Syndrome. Holistic patient care and therapy must include all pathologic alterations of the Syndrome. This concept also fertilised the therapeutic possibilities of the prevention. Cleaning of up-to-date insulin preparations, with their better timing effect, contributed a lot to achieve and maintain normoglycemia. Besides rapid acting insulin analogues, long acting analogues are available on the market, with a significantly smoother effect. These new preparations provide a near ideal insulin effect. Modern oral antidiabetics try to restore physiologic circumstances. Their combined application in type 2 diabetes--in the majority of these patients--is able to maintain normoglycemia. In case when oral drugs seem to be ineffective in obtaining physiologic conditions, insulin therapy should introduced as early, as possible. Data gained from up-to-date clinical investigations, offer evidence about inflammatory origin of atherosclerosis, type 2 diabetes, and the Metabolic Syndrome as well. This new concept changes very likely therapeutic implications in the (very) next future. It seems, that widespread and radical transformation about our notion according to the diabetes syndrome, has priority in everyday practice. New insulin and oral preparations--together with frequent home checking of blood pressure and blood sugar--just comply with our new concept.
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