Optimal diabetes control in adults

Management principals

1. Preserve Beta cell function.

2. Early aggressive treatment.

3. Reduce glucose toxicity.

4. Treat to target.

5. Information and education.

Three corner stones of therapy Diet

Exercise

Medication

Additional metabolic targets BP: 130/80 mmHg (with no proteinuria). BP: 125/75 mmHg (with proteiuria). Total cholesterol < 5mmol/L LDL cholesterol < 3mmol/L (diabetes only)

< 2.6mmol/L(additional risk factors) HDL cholesterol > 1mmol/L Trigliserides < 1.7mmol/L BMI = 20-24 kg/m2

Waist circumfence = 102 cm (f), 88cm (m).

Medication for Type 2 diabetic patient

6 classes of drugs:1. Sulphonylurea

2. Biguanide

3. Acarbose

4. Meglitinides

5. Thiazolidinediones

6. Insulin

PHARMACOLOGICAL MANAGEMENT

SITES OF ACTION OF CURRENT ORAL ANTIDIABETIC AGENTS

Liver: glucose production - biguanides - thiazolidinediones

Pancreas: insulin secretion - sulphonylureas - meglitinides

insulin replacement - insulin

PHARMACOLOGICAL MANAGEMENT

SITES OF ACTION OF CURRENT ORAL ANTIDIABETIC AGENTS

Adipose tissue: peripheral glucose uptake and and muscle utilization - thiazolidinediones - biguanides

Intestine: glucose absorption - alpha-glucosidase inhibitors

Biguanides : metformin(glucophage)

Mechanism of action Inhibits hepatic glucose prodution

(gluconeogenesis). Increases the sensitivity of peripheral tissue to

insulin. Increases peripheral glucose uptake. Decreases glucose absorption from the intestine.