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ORAL
THERAPY

ORAL
THERAPY

ORAL THERAPY
FOR PATIENTS WITH TYPE 2 DIABETES

In the early stages, patients with Type 2 diabetes can often achieve normal glucose results through a modification of lifestyle and eating habits. In the event that this is unsuccessful, the following step-by-step process is followed.

TRADITIONAL STEP-BY-STEP PROCESS

  • Begin monotherapy with an oral agent (Metformin is usually the first drug utilised)
  • Increase dose of monotherapy until recommended dose is maximised
  • If monotherapy does not achieve glycaemic control, a second oral agent is added and the pattern is repeated
  • Insulin is added, as a last resort, if glucose control is not achieved with maximum doses of oral medications

Typically, each of these steps should be tried for four to six weeks before moving to the next one. Unfortunately, during this period, elevated blood glucose levels can be harmful and should be taken care of.

However, for some individuals, non-pharmacologic interventions sufficiently maintain good glycaemic control. In the early stages, patients with Type 2 diabetes may be able to maintain adequate glucose control through diet, exercise, and modest weight loss.

You might also consider putting your patients through nutrition counselling courses, teaching them how to recognise, count, and modify their daily carbohydrate intake. Along with these lessons, you can educate your patients on eating low-fat, well-balanced meals that stimulate modest weight loss. Mild to moderate exercise is also encouraged for almost everyone, as this can be quite effective.

Keep a check on your patients’ glycaemic profile

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ORAL MEDICATIONS

If diet and exercise fail to achieve sufficient glycaemic control, there are many oral medications that can be prescribed.

Though it is not important for you to memorise the specific details of each medication, it is important to know and understand the problems caused by Type 2 diabetes, the various systems of the body that are affected, and how the oral medications work to counteract these problems.

Effective pharmacologic solutions will vary from person to person, as hyperglycaemia may result from one or a combination of the following issues:

  • A pancreas that does not make sufficient insulin
  • A liver that releases too much glucose
  • Muscle cells that are resistant and do not utilise insulin sufficiently
  • Depending on how far the disease has progressed before diagnosis, it can take several months to achieve good control through the step-by-step process of traditional treatment6,7
  • Losing just 10% of body weight can substantially lower glucose levels and bring the condition back under control8
  • Approximately 90% of individuals with Type 2 diabetes require oral medication, insulin, or both9
  • Insulin dependent Type 2 patients typically do extremely well on insulin pump therapy7. This population should become one of your key targets for improving patient lives.

Use of insulin

Due to the chronic and progressive nature of Type 2 diabetes, some patients eventually require external insulin, which may be prescribed alone or in combination with other oral medications. Unfortunately, use of insulin to achieve sufficient glycaemic control is viewed as a ‘last resort’ treatment. 

6. Franz, M.J. (Ed.). (2003). A CORE Curriculum for Diabetes Education: Diabetes Management Therapies (5th ed.). Chicago: American Association of Diabetes Educators.

7. AADE Quick Guide to Medications. A Handbook on Treatment Options. (2008 Revised Update).

8. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. (2003). Report of the expert committee on the diagnosis and classification of diabetes mellitus. The Journal of Clinical and Applied Research and Education: Diabetes Care, 26(Suppl.1), S5-S20.

9. American Diabetes Association. (2010). Standards of medical care in diabetes-2010. The Journal of Clinical and Applied Research and Education: Diabetes Care, 233(Suppl. 1), S6-S69.

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