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  • Title: Consulting on the patient with type 2 diabetes: matching medication to disease mechanism.
    Journal: Manag Care; 2007 Jun; 16(6 Suppl 5):2-11. PubMed ID: 17703795.
    Abstract:
    Type 2 diabetes places a significant burden on the health care system today and its incidence is expected to increase at an alarming rate over the next 20 years. Type 2 diabetes is associated with increasing insulin resistance and beta-cell dysfunction, and with macro- and microvascular complications (including cardiovascular disease, retinopathy, peripheral neuropathy, and end-stage renal disease). The primary rationale for intensive management of type 2 diabetes is to reduce or prevent microvascular and cardiovascular events; therefore, treatment goals encompass glycemic, blood pressure, and lipid targets. Thiazolidinediones (TZDs) improve insulin sensitivity and preserve beta-cell function, and clinical evidence supports the early use of these agents in preventing the progression of diabetes in high-risk patients. The durability of glycemic control with monotherapy varies among orally available antidiabetic agents, and, inevitably, patients with type 2 diabetes will require a combination of antidiabetic agents to reach glycemic goals. Fixed-dose combination therapy is associated with increased adherence to the treatment regimen and improved outcomes. Intensive management of patients with type 2 diabetes has been shown to decrease the rate of complications and reduce health care costs.
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