Volume 110, Issue s77

The prevalence of diabetes is expected to grow both nationally and globally. Therefore, increased effort to reduce the incidence of this disease is warranted. Physicians must be able to identify individuals who are at risk for diabetes and implement strategies to prevent diabetes onset. Because early diagnosis is critical for reducing the complications of type 2 diabetes mellitus (T2DM), physicians must actively screen for and diagnose diabetes in their practice. Physicians must also be knowledgeable of the recommendations for glycemic goals and apply the treatment algorithms put forth by the American Diabetes Association/European Association for the Study of Diabetes and the American Association of Clinical Endocrinologists/American College of Endocrinology in the management of patients afflicted with T2DM.

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of microvascular and macrovascular complications. To manage T2DM, the American Diabetes Association recommends lowering glycated hemoglobin levels to less than 7%, but even lower goals may be possible in patients with low risk of hypoglycemia. Although many studies have demonstrated that aggressive glycemic control has a clear benefit in the reduction of microvascular complications, more data are needed to further characterize the effect on macrovascular complications. Furthermore, researchers must consider the evidence of a “legacy effect,” in which benefits do not become evident until years later. The risks of aggressive glycemic control, such as hypoglycemia and weight gain, must be weighed against the benefits in each individual patient.

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular complications. This increased risk is present even before the diagnosis of diabetes is made. Therefore, it is imperative that physicians are aware of risk factors for diabetes and actively screen high-risk patients and diagnose the condition as early as possible. Patients with prediabetes must be counseled on interventions to prevent the progression to diabetes. Integrated treatment plans that address all aspects of disease must be implemented. Patients with diabetes should be examined for dyslipidemia, overweight or obesity, and hypertension. Treatment for patients with T2DM should include lifestyle interventions and should address any other comorbidities for which the patient may be at risk.

Incretins are hormones that are released after ingestion of a meal and augment the secretion of insulin. Current research suggests that GLP-1 (glucagon-like peptide 1) is the most important. Their action is terminated by enzymes known as dipeptidyl peptidase-4 (DPP-4). The observation that the incretin response may be diminished in individuals with type 2 diabetes mellitus has led to advances in the management of this disease. Agents that act as incretin mimetics, such as exenatide and liraglutide, and DPP-4 inhibitors, such as sitagliptin phosphate and saxagliptin, improve glycated hemoglobin levels either as monotherapy or in combination with other agents. Importantly, these agents either lead to weight loss or are weight neutral and are associated with a low risk of hypoglycemia—properties that further contribute to their clinical utility.

The following illustrative case presentation was introduced by Jeffrey S. Freeman, DO, at the symposium titled “Incretin-Based Therapies: Bridging the Gap Between Clinical Experiences and Emerging Applications in Type 2 Diabetes.” The program was conducted Thursday, November 5, 2009, at the American Osteopathic Association's 114th Annual Osteopathic Medical Conference and Exposition in New Orleans, Louisiana. Discussion excerpts from the symposium participants regarding treatment options for the patient are included.