Optimizing glycemic control and minimizing the risk of hypoglycemia in patients with type 2 diabetes

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Abstract

Diabetic microvascular and macrovascular complications arise from hyperglycemia, presenting an increasing healthcare burden as the diabetic population continues to grow. Clinical trial evidence indicates that antihyperglycemic medications are beneficial with regard to microvascular disease (retinopathy, renal impairment, and perhaps neuropathy); however, the benefit of aggressive use of these medications with regard to cardiovascular risk has been less clear in recent studies. These studies were confounded by the propensity of the antihyperglycemic medications involved to cause hypoglycemia, which itself presents cardiovascular risk. This article presents additional context for these seemingly discordant results and maintains that the achievement of glycemic targets is warranted in most patients and provides cardiovascular benefit, provided that hypoglycemia is avoided and the treatment regimen is tailored to the needs of the individual patient. A treatment approach that is driven by these principles and emphasizes diet and exercise, a combination of noninsulin antidiabetic agents, not including sulfonylureas and glinides, and judicious use of insulin is also presented.

Keywords: clinical management, cardiovascular risk, hypoglycemia, type 2 diabetes mellitus

Citation: Schwartz SS. Optimizing glycemic control and minimizing the risk of hypoglycemia in patients with type 2 diabetes. Drugs in Context 2013;212255. doi: 10.7573/dic.212255

Provenance: Submitted; externally peer reviewed

Dates: Submitted: 7 March 2013; Accepted, subject to peer review: 11 March 2013; Published: 22 May 2013

Copyright: © 2013 Schwartz SS. This is an open-access article distributed under the terms of the Creative Commons Attribution License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No other uses without permission.

Correct attribution: Copyright © 2013 Schwartz SS. http://dx.doi.org/10.7573/dic.212255. Published by Drugs in Context under Creative Commons Attribution License Deed CC BY NC ND 3.0.

Correspondence: Stanley S Schwartz MD, 233 E. Lancaster Ave, Suite 233, Ardmore, PA 19003, USA

Email: stschwar@gmail.com

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