How to control diabetes
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Summary
10 papers analyzed
These studies suggest that controlling diabetes involves a combination of structured glucose management, controlled diet, exercise, advanced medical technologies, and careful use of medications to reduce complications and maintain optimal blood sugar levels.
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Effective Strategies for Diabetes Control
Optimizing Blood Glucose Levels
Fasting Blood Glucose Management
A structured approach to managing Type 2 diabetes by targeting near-normal fasting blood glucose levels (4-6 mmol/L) can effectively control blood glucose with minimal risk of hypoglycemia. This strategy involves regular 3-monthly fasting blood glucose checks and the use of up to two therapeutic agents. If diet and oral therapy are insufficient, adding a basal insulin supplement can help achieve near-normal levels.
Continuous Glucose Monitoring (CGM)
For Type 1 diabetes, continuous glucose monitoring combined with an insulin advisory system can significantly reduce glucose variability and hypoglycemia. This system uses automated insulin titration and bolus calculation, providing personalized glucose management.
Dietary Management
Controlled Diets
Maintaining a controlled diet with a balanced distribution of carbohydrates, proteins, and fats is crucial. This approach aims to keep blood and urine sugar levels normal, reducing the risk of degenerative complications. Although ideal control is challenging, consistent efforts can lead to reasonably good control.
Lifestyle and Self-Management
Good glycemic control is often associated with specific lifestyle practices. Patients who manage their diabetes well tend to exercise regularly, prefer non-caloric beverages, and have a comprehensive approach to their condition. In contrast, poor control is linked to economic and emotional issues, and less healthy dietary choices.
Intensive Glucose Control
Microvascular and Macrovascular Outcomes
Intensive glucose control in Type 2 diabetes can reduce the risk of microvascular complications such as kidney and eye events. However, its impact on macrovascular outcomes like major cardiovascular events is modest, with a slight reduction in myocardial infarction risk but no significant decrease in overall mortality .
Metformin Use
For overweight patients with Type 2 diabetes, intensive glucose control with metformin can reduce the risk of diabetes-related endpoints, including death. Metformin is associated with less weight gain and fewer hypoglycemic episodes compared to insulin and sulfonylureas, making it a preferred first-line therapy.
Technological and Pharmacological Advances
Newer Agents and Insulin Analogues
Newer agents such as GLP-1 analogues, DPP-4 inhibitors, and long-acting insulin analogues offer effective glycemic control. These agents can improve HbA1c levels and have additional benefits like weight loss and reduced hypoglycemia. However, their cost-effectiveness varies, with some being more expensive than traditional therapies.
Artificial Pancreas and Automated Systems
The development of an artificial pancreas and automated closed-loop control systems represents a significant advancement in diabetes management. These systems integrate continuous glucose sensors and insulin delivery devices, offering a promising future for automated diabetes control.
Conclusion
Effective diabetes control involves a combination of structured blood glucose management, controlled diets, lifestyle modifications, and the use of advanced technologies and pharmacological agents. Intensive glucose control can prevent microvascular complications, while newer agents and automated systems offer personalized and efficient management options. Tailoring treatment to individual needs remains crucial for optimal outcomes.
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