COMMENTARY

Individualized Treatment Key to Improving Type 2 Diabetes Outcomes

April 28, 2017

Richard Pratley, MD, director of the Florida Hospital Diabetes Institute, discussed new therapies for improving management of patients with type 2 diabetes at the NAMCP Spring Managed Care Forum 2017.

During the presentation, Dr Pratley explained that type 2 diabetes is a progressive disease with multiple preventive measures available to halt or reverse disease progression. He noted that type 2 diabetes also presents the risk for major microvascular complications.  Type 2 diabetes patients are also at risk for retinopathy, lower-limb amputation, and kidney failure.

Dr Pratley presented data that compared and contrasted current and emerging therapies for reaching individualized treatment goals for patients with type 2 diabetes. He explained that diet and lifestyle changes should always be the foundation of therapy—and that additional therapy should be personalized based on clinical presentation. Factors such as patient preference, comorbid conditions, and life expectancy should be taken into consideration when determining a management and treatment strategy.

Dr Pratley suggested that metformin should usually be used as a first-line treatment. He presented an in-depth breakdown of all of the available options for improving glycemic control in the event that metformin treatment fails.

Among the second-line treatments, Dr Pratley highlighted basal insulin, which he explained is ideal for patients with either nocturnal hypoglycemia, shift work, or adherence issues.

Dr Pratley also explained that cardiovascular risk reductions should be a major part of all treatment plans and broke down some of the latest CV outcomes trials—including Onglyza (Saxagliptin; AstraZeneca),  Nesina (alogliptin; Takeda), and Januvia (Sitagliptin; Merck).

He concluded by highlighting how improving diabetes management and treatment has significantly reduced the risk for complications related to MI, stroke, amputation, and kidney failure. —David Costill