Volume 111, Issue s75

Type 2 diabetes mellitus (T2DM), obesity, and cardiovascular disease (CVD) share a common pathogenic mechanism. The prevalence of each of these conditions is increasing at an alarming rate. Despite the availability of several treatment options for patients with T2DM and the use of intensive regimens combining several antidiabetic drugs, less than half of all patients reach a target glycosylated hemoglobin level of less than 7%. Given the rapid increase in the number of patients with T2DM and obesity, as well as the CVD morbidity and mortality associated with this burden, efforts must be made to change the course of disease. The author reviews clinical trial data on the effect of glucose control on CVD risk, the selection and timing of antihyperglycemic agents, the management of associated CVD risk factors, and strategies to improve patient adherence and acceptance—with the goal of assisting physicians in selecting appropriate management strategies for their patients with T2DM.

Effective glycemic control is essential to minimize the long-term complications of type 2 diabetes mellitus (T2DM). However, it is well documented that many patients spend prolonged periods outside of the optimal glycemic range. The use of insulin is important to effectively control the disease process in patients with T2DM. Even so, resistance to insulin use among patients and healthcare providers often limits initiation and intensification of insulin therapy. With the increasing prevalence of T2DM across all socioeconomic strata, an expanded viewpoint of early and sustained insulin use is crucial to enhance glycemic control in patients. To manage the effects of T2DM on cardiovascular disease in the aging population, physicians can promote insulin therapy as an affordable and effective treatment option. The author reviews beliefs and myths about the use of insulin in the management of T2DM and discusses strategies to overcome barriers to initiation of insulin therapy in the primary care setting.

As knowledge of pathophysiologic mechanisms of diabetes mellitus has increased, clinical attention has shifted to the incretin system. Incretin hormones, including glucagon-like peptide-1, or GLP-1, and glucose-dependent insulinotropic polypeptide, are vital to the control of glucose homeostasis and pancreatic β-cell preservation. Novel strategies for the treatment of patients with type 2 diabetes mellitus (T2DM) engage the incretin system. Glucagon-like peptide-1 receptor agonists provide robust glycemic control as well as beneficial reductions in body weight. Dipeptidyl peptidase-4, or DPP-4, inhibitors exhibit beneficial glycemic effects and are weight-neutral. Incretin-based medications are becoming increasingly recognized in guidelines as early treatment options because of their efficacy and well-tolerated profiles. The author reviews the safety and efficacy of currently approved incretin-based agents, as well as the role of these medications in treatment paradigms for patients with T2DM. He also discusses investigational incretin-based agents.