CLINICAL PEARL Type 2 Diabetes: Lifestyle Changes and Drug Treatment

More than 23 million individuals in the United States have diabetes—a figure that creates great urgency for finding the most effective and safest methods for treatment. Data show that therapies that lower hyperglycemia to the normoglycemic range can reduce morbidity, cardiovascular mortality, and microvascular complications in type 1 diabetes [1-3]. Likewise, intensive treatment strategies for type 2 diabetes have demonstrated a reduction in microvascular disease, but more recent data show no reduction in macrovascular disease [4-7]. Due to the potential for complications, initial treatment for decreasing hyperglycemia should be patient-specific and adjusted to achieve the American Diabetes Association (ADA) target A1c level of less than 7 percent [8]. While oral and injectable pharmacotherapies and insulin are often needed to maintain this level, the importance and benefit of lifestyle changes should not be undervalued. According to the 2008 consensus statement from the ADA and European Association for the Study of Diabetes, lifestyle interventions and metformin therapy should be started concurrently upon diagnosis of type 2 diabetes [9]