General Principles for Diabetes Mellitus Management

Because the 'Tsunami of type 2 diabetes' is presently rolling on a global scale, owing to the ever-increasing prevalence of obesity, increasing physical inactivity, and aging populations worldwide, the economic burden of diabetes caused by increased health resource use and lost productivity increase rapidly. So prevention in general population and good glycemic controls become even more important with earlier diagnosis and more aggressive cardiovascular prevention and treatment. Diabetes requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is very complex and requires that many issues, beyond glycemic control, be solved by the active governmental policy. Lifestyle modifications are the cornerstones of management of type 2 diabetes. The progressive nature of type 2 diabetes requires use of one or more oral agents and eventually insulin, along with lifestyle modification and intensification. Rapid achievement of the target goals often prompts providers to consider combination therapy to target different pathogenic mechanisms and manage both fasting and postprandial blood glucose levels. Maintenance of glycemic control over the lifespan of a patient with diabetes is overwhelmingly likely to require combination therapy with oral diabetes medications. Ultimately, because of the progressive nature of the disease and the progressive decline in pancreatic beta-cell function, insulin therapy is almost always obligatory to achieve optimal glycemic goals.