Treatment Options to Control Blood Glucose

Treatment Option A: No Pharmacotherapy at This Time

Patients who are newly diagnosed with type 2 diabetes may initially reach target glucose levels through improved diet and exercise. However, because of the progressive nature of diabetes, which includes insulin resistance and a decline in ß-cell function,¹ glycemic control will not be maintained indefinitely through such lifestyle interventions alone.² Pharmacologic interventions early in the disease, as reported in the United Kingdom Prospective Diabetes Study (UKPDS), suggest a significant decrease in disease complications such as neuropathy, retinopathy, and nephropathy³ as well as a trend toward reducing the potential for such macrovascular complications as coronary heart disease, particularly in patients with comorbid risk factors.² For more information about the UKPDS, see the Pivotal Literature section of this Web site (diabetesroundtable.com).

Comment: Mrs. S likely has new-onset diabetes mellitus. At presentation, fingerstick blood sugars were severely elevated and she is symptomatic. Lab results confirming plasma glucose (PG) over 200 mg/dL in the presence of symptoms of hyperglycemia will confirm the diagnosis. This degree of hyperglycemia is unlikely to be controlled adequately with lifestyle modification alone. When such a degree of hyperglycemia is present, pharmacotherapy, in addition to lifestyle intervention, is indicated to control symptoms and prevent disease complications.

Which option for pharmacotherapy would you select?

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