How is diabetes treated
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Summary
10 papers analyzed
These studies suggest that diabetes is treated using insulin therapy, continuous glucose monitoring, and combination therapies for type 1 diabetes, while type 2 diabetes is managed with medications like metformin, GLP-1 RA, SGLT-2i, and comprehensive care approaches.
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Diabetes Treatment Approaches
Insulin Therapy in Type 1 Diabetes
Continuous Subcutaneous Insulin Infusion (CSII) and Multiple Daily Injections (MDI)
For adolescents with type 1 diabetes, intensive therapy involving either multiple daily injections (MDI) of insulin or continuous subcutaneous insulin infusion (CSII) is recommended to achieve better metabolic control and prevent complications. Studies have shown that while both methods initially improve metabolic control, CSII tends to sustain lower HbA1c levels over a 12-month period compared to MDI. Additionally, CSII significantly reduces the rate of severe hypoglycemic events and improves psychosocial outcomes such as self-efficacy, depression, and quality of life.
Intensive Diabetes Treatment
Intensive diabetes treatment, which includes the use of insulin pumps or multiple daily injections along with frequent blood-glucose monitoring, has been shown to delay the onset and slow the progression of complications such as retinopathy and nephropathy in adolescents with type 1 diabetes. However, this approach is associated with an increased risk of severe hypoglycemia.
Emerging Therapies
Recent studies suggest that adding novel treatments like golimumab, an antibody against tumor necrosis factor-α, can slow disease progression and reduce insulin requirements in newly diagnosed type 1 diabetes patients, offering a promising addition to existing therapies.
Pharmacological Treatments for Type 2 Diabetes
Metformin and Combination Therapies
Metformin remains the first-line treatment for type 2 diabetes due to its efficacy, versatility, and cost-effectiveness. It is often used in combination with other medications such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter inhibitors (SGLT-2i), which offer additional benefits for HbA1c reduction, weight loss, and cardiovascular health.
Pathophysiologic Approach
A pathophysiologic approach to treating type 2 diabetes involves using combination therapies that target specific pathophysiologic defects, such as insulin resistance and β-cell failure. This method is tailored to the patient's overall health and associated medical conditions, aiming for early and sustained glycemic control.
Insulin Therapy
Insulin therapy is often necessary as type 2 diabetes progresses and β-cell function declines. Intensive glucose control with insulin has been shown to delay the onset and progression of microvascular complications. Combination therapies with insulin and oral antidiabetic medications can be effective, especially for patients who do not achieve adequate glycemic control with oral agents alone .
Continuous Glucose Monitoring (CGM)
The use of continuous glucose monitoring (CGM) systems can significantly improve blood sugar control in patients with type 2 diabetes. CGM allows for better insulin dose adjustments and can eventually enable patients to transition from insulin therapy to oral antidiabetic medications and GLP-1 receptor agonists, maintaining good glycemic control.
Conclusion
Diabetes treatment involves a multifaceted approach that includes insulin therapy, oral medications, and lifestyle modifications. For type 1 diabetes, intensive insulin therapy and emerging treatments like golimumab show promise. In type 2 diabetes, metformin remains the cornerstone of treatment, often supplemented with combination therapies targeting specific pathophysiologic defects. Continuous glucose monitoring further enhances treatment efficacy, allowing for better management and potential reduction in insulin dependency.
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