HealthReach Diabetes Endocrine, Nutrition Center, Hampton, NH 03842, USA.
Postgrad Med. 2010 May;122(3):7-15. doi: 10.3810/pgm.2010.05.2137.
The prevalence of type 2 diabetes mellitus has reached epidemic proportions. Current treatment options for patients with diabetes include lifestyle modifications (eg, diet and exercise) along with pharmacotherapy (eg, oral antidiabetic drugs [OADs], incretin-based therapies, and insulin). Despite the availability of effective and safe treatments, many patients do not achieve recommended glycemic targets, thereby increasing their risk of long-term complications. Given the progressive nature of diabetes and the need for extensive patient management, it is important that physicians and patients develop a partnership to achieve therapeutic goals. At diagnosis, the diabetes care team, led by the patient, should evaluate all aspects of management, including appropriate treatment options that are suited to the patient's quality of life, convenience, and therapeutic goals. Treatment should also consider the patient's comorbidities, including hypertension and obesity. Management of early type 2 diabetes should include OADs and incretin-based therapies, and preference should be given to agents that do not cause either hypoglycemia or weight gain. A basal insulin should be initiated if glycemic control is not achieved with >or= 1 agents or if presenting glucose control is poor. Irrespective of pharmacotherapy, all patients should be encouraged to maintain a healthy diet and exercise regimen. Patients also need to become active participants in disease management by monitoring blood glucose, complying with medication, adhering to lifestyle modifications, and setting weight loss goals when appropriate. This article emphasizes the need for physicians and other health care providers to partner with patients to achieve therapeutic goals and presents a novel, multifaceted approach toward improving the management of diabetes in a clinical practice setting.
2 型糖尿病的患病率已达到流行程度。目前,糖尿病患者的治疗选择包括生活方式改变(例如,饮食和运动)以及药物治疗(例如,口服降糖药 [OAD]、基于肠促胰岛素的治疗和胰岛素)。尽管有有效的和安全的治疗方法,许多患者仍未达到推荐的血糖目标,从而增加了他们发生长期并发症的风险。鉴于糖尿病的进展性质和对广泛患者管理的需求,医生和患者建立治疗目标的伙伴关系非常重要。在诊断时,应由患者领导的糖尿病护理团队评估管理的各个方面,包括适合患者生活质量、便利性和治疗目标的适当治疗选择。治疗还应考虑患者的合并症,包括高血压和肥胖症。早期 2 型糖尿病的管理应包括 OAD 和基于肠促胰岛素的治疗,并应优先选择不会引起低血糖或体重增加的药物。如果使用≥1 种药物未能控制血糖或现有血糖控制不佳,则应开始使用基础胰岛素。无论是否进行药物治疗,都应鼓励所有患者保持健康的饮食和运动方案。患者还需要通过监测血糖、遵守药物治疗、坚持生活方式改变以及在适当情况下设定减肥目标,积极参与疾病管理。本文强调了医生和其他医疗保健提供者与患者合作以实现治疗目标的必要性,并提出了一种新颖的、多方面的方法,以改善临床实践中糖尿病的管理。
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