Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

Diabetes Mellitus, Type 2 477

■Assess degree of control, presence of complications, or associated

conditions

General Measures

■Self-monitoring of glucose

■Attention to meal planning (diet), weight loss if indicated

■Regular exercise

■Continuing education

Treatment Goals

■Glucose:

➣Preprandial: 80–120 mg/dL

➣Bedtime: 100–140 mg/dL

➣HgbA1c: <7%

➣Must be individualized based on ability to understand and carry

out treatment regimen, risk of hypoglycemia, advanced age, renal

disease, CVD

➣BP: <130/80 mmHg

➣Lipids: LDL cholesterol <100 mg/dL

specific therapy

■Metformin: currently first-line agent; can be used in combination

with other oral agents or with insulin

■Sulfonylureas:

➣Several available: tolazamide, chlorpropamide, glyburide, glip-

izide, glimepiride, rapaglinide, nateglinide

➣Chlorpropamide, glyburide, and glimepiride have long half-

lives, glipizide and tolazamide intermediate, and rapaglinide and

nateglinide very short

➣Add to metformin or use as first-line agent

■Glitazones (thiazolidinediones):

➣Rosiglitazone, pioglitazone

➣Add to metformin or sulfonylurea

➣Not generally first-line agent, but can be used as monotherapy

■Alpha-glucosidase inhibitors:

➣Acarbose, miglitol

➣Add to first-line agents

■Insulin:

➣Use exclusively in pregnant and nursing mothers, in patients with

significant liver disease, and in anyone not adequately controlled

on oral agents

➣Use in combination with oral agents or alone