What are the recommended blood glucose ranges for type 2 diabetes. How can individuals effectively monitor their blood sugar levels. What lifestyle changes and medications can help manage type 2 diabetes.

Understanding Blood Glucose Ranges for Type 2 Diabetes

Type 2 diabetes (T2D) is a chronic condition characterized by elevated blood sugar levels due to the body’s ineffective use of insulin. Maintaining appropriate blood glucose ranges is crucial for managing T2D and preventing potential complications.

Health experts recommend the following target ranges for individuals with T2D:

• 80-130 mg/dL before meals
• Less than 180 mg/dL 2 hours after meals

These ranges help minimize the risk of diabetes-related health issues, such as heart disease, vision loss, and kidney problems. However, it’s important to note that target ranges may vary based on individual factors like age and overall health.

The Importance of A1C Testing

In addition to daily blood glucose monitoring, individuals with T2D typically undergo regular A1C tests. This blood test provides insight into average blood sugar levels over the past three months. Maintaining an A1C level of 7% or below can significantly reduce the risk of diabetes complications.

Methods for Monitoring Blood Glucose Levels

Effective blood glucose monitoring is essential for managing T2D. There are two primary methods individuals can use to check their glucose levels:

1. Finger-prick tests
2. Continuous glucose monitoring (CGM)

Finger-Prick Tests

This traditional method involves:

• Placing a test strip in a glucose meter
• Pricking the finger with a small needle
• Applying a drop of blood to the test strip
• Reading the glucose level displayed on the meter

Continuous Glucose Monitoring (CGM)

CGM offers a more advanced approach to glucose monitoring:

• A small sensor is worn on the body
• The sensor measures glucose levels in interstitial fluid
• Data can be scanned with a device or smartphone
• Some CGM systems automatically send data to smart devices

Is CGM more accurate than finger-prick tests? While both methods are reliable, CGM provides more frequent readings and can detect trends over time, offering a more comprehensive view of glucose fluctuations.

Lifestyle Changes for Managing Type 2 Diabetes

Managing T2D often requires a multifaceted approach that includes lifestyle modifications. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends several key changes:

Nutrition and Diet

Adopting a balanced, nutritious diet is crucial for managing T2D. This may involve:

• Focusing on whole grains, lean proteins, and vegetables
• Limiting processed foods and added sugars
• Controlling portion sizes
• Monitoring carbohydrate intake

How does diet impact blood glucose levels? The foods we consume directly affect our blood sugar, with carbohydrates having the most significant impact. Learning to balance carbohydrate intake can help stabilize glucose levels throughout the day.

Physical Activity

Regular exercise plays a vital role in managing T2D by:

• Improving insulin sensitivity
• Helping to maintain a healthy weight
• Reducing stress and improving overall well-being

The American Diabetes Association recommends at least 150 minutes of moderate-intensity aerobic activity per week, spread over at least three days.

Weight Management

For individuals with excess weight, losing even a small percentage of body weight can significantly improve blood glucose control. This can be achieved through a combination of diet and exercise.

Stress Management

Chronic stress can negatively impact blood glucose levels. Implementing stress-reduction techniques such as meditation, deep breathing exercises, or yoga can be beneficial for overall diabetes management.

Medications for Type 2 Diabetes Management

When lifestyle changes alone are insufficient to manage T2D, healthcare providers may prescribe medications to help control blood glucose levels. These medications fall into two main categories:

1. Oral medications
2. Injectable medications

Oral Medications

Metformin is typically the first-line medication prescribed for T2D. It works by:

• Reducing glucose production in the liver
• Improving insulin sensitivity in the body

Other oral medications may include:

• Sulfonylureas
• DPP-4 inhibitors
• SGLT2 inhibitors
• Thiazolidinediones
• Alpha-glucosidase inhibitors

Each class of medication works differently to help control blood glucose levels. Healthcare providers consider various factors when selecting the most appropriate medication for each individual.

Injectable Medications

In some cases, injectable medications may be necessary. These include:

• Insulin: Various types of insulin are available, ranging from rapid-acting to long-acting formulations
• GLP-1 receptor agonists: These medications stimulate insulin production and reduce glucose production in the liver

How do healthcare providers determine which medication is best? The choice of medication depends on several factors, including the individual’s overall health, treatment goals, potential side effects, and how well the body tolerates the medication.

Monitoring and Adjusting Treatment Plans

Managing T2D is an ongoing process that requires regular monitoring and adjustments to the treatment plan. This may involve:

• Regular check-ups with healthcare providers
• Periodic A1C tests
• Adjusting medications as needed
• Addressing any diabetes-related complications

Open communication with healthcare providers is essential to ensure that the treatment plan remains effective and aligned with the individual’s changing needs and health status.

Potential Complications of Type 2 Diabetes

Uncontrolled T2D can lead to various complications, including:

• Cardiovascular disease
• Kidney damage (nephropathy)
• Eye damage (retinopathy)
• Nerve damage (neuropathy)
• Foot problems
• Skin conditions

Maintaining blood glucose levels within the recommended ranges can significantly reduce the risk of these complications. Regular screenings and check-ups are crucial for early detection and management of any developing issues.

Emerging Treatments and Research in Type 2 Diabetes

The field of diabetes management is continually evolving, with ongoing research into new treatments and technologies. Some areas of current interest include:

• Artificial pancreas systems
• Gene therapy
• Stem cell treatments
• Novel drug combinations
• Personalized medicine approaches

These advancements hold promise for improving the lives of individuals with T2D, potentially offering more effective and less burdensome treatment options in the future.

Are there any potential cures for type 2 diabetes on the horizon? While a cure for T2D remains elusive, ongoing research continues to improve our understanding of the disease and develop more effective management strategies. Some studies are exploring the potential for reversing T2D through intensive lifestyle interventions or bariatric surgery in certain individuals.

Living Well with Type 2 Diabetes

Despite the challenges of managing T2D, many individuals lead fulfilling and healthy lives with the condition. Key aspects of living well with T2D include:

• Educating oneself about the condition
• Building a strong support network
• Staying consistent with medication and lifestyle changes
• Practicing self-compassion and avoiding perfectionism
• Celebrating small victories in diabetes management

How can individuals with T2D maintain a positive outlook? Focusing on the aspects of diabetes management within one’s control, seeking support when needed, and acknowledging progress can help maintain a positive mindset. Many people find that joining diabetes support groups or working with a mental health professional can be beneficial in navigating the emotional aspects of living with T2D.

In conclusion, managing type 2 diabetes requires a comprehensive approach that includes understanding blood glucose ranges, regular monitoring, lifestyle modifications, and appropriate medication use. By working closely with healthcare providers and staying informed about the latest developments in diabetes care, individuals with T2D can effectively manage their condition and reduce the risk of complications. Remember that diabetes management is a journey, and with the right tools and support, it’s possible to lead a healthy, fulfilling life with type 2 diabetes.

What are the blood glucose ranges for a person with type 2 diabetes?

Type 2 diabetes (T2D) is a health condition that may cause a person’s blood sugar levels to become too high. It is important to monitor blood glucose and keep it within an appropriate range to help manage the condition.

T2D occurs when a person’s body can no longer effectively use the insulin their pancreas produces. Doctors call this insulin resistance. When the pancreas cannot keep up and blood sugar rises, it sets the stage for prediabetes and T2D.

High blood sugars can damage the body and result in serious health complications, such as heart disease, vision loss, and kidney disease. It is advisable to keep blood sugar levels within suitable ranges to help prevent health problems.

For individuals with T2D, health experts recommend aiming to keep blood sugars between 80 and 130 milligrams per deciliter (mg/dL) before a meal and less than 180 mg/dL 2 hours after.

In this article, we will discuss suitable ranges for blood sugars and how to monitor blood glucose.

Health experts advise that a person living with T2D should aim to keep their blood glucose range between 80 and 130 mg/dL before a meal and less than 180 mg/dL 2 hours after.

As part of routine diabetes management, a person will often also require an A1C test. This is a blood test that a healthcare professional performs to provide information on a person’s average blood glucose levels over the past 3 months.

Depending on a person’s diabetes history and general health, they may have different A1C targets. However, research suggests that someone can reduce the risks of diabetes complications by maintaining an A1C of 7% or below.

Learn more about managing and lowering A1C levels.

Glucose goals vary from person to person. Someone living with T2D can regularly discuss managing diabetes with a doctor.

During this process, a health professional will adapt a person’s care plan, including their glucose ranges. The target ranges may vary depending on several factors. These can include age or any additional health issues an individual may have.

There are two main ways a person can self-check their glucose levels.

The first is via a finger-prick test. This involves placing a test strip in a meter, then using a needle to prick the person’s finger. This will draw a small amount of blood that a healthcare professional can test. By placing blood on the test strip, the meter can provide a glucose reading.

The second method is through continuous glucose monitoring (CGM). This involves wearing a sensor, which a person can scan with a small device or smartphone. Alternatively, the sensor can link with a smart device and send data to it independently. Unlike finger-pricking, CGMs do not measure glucose in the blood. Instead, it measures interstitial fluid, which refers to the amount of glucose in the fluid surrounding a person’s cells.

When living with T2D, there are several regime related activities a person needs to do to manage the condition. A medical professional will typically work with individuals to help develop a care plan. This may involve making lifestyle changes and taking prescribed medications.

Managing blood glucose may vary depending on several factors, such as whether a person has obesity, their age, and if they have any underlying conditions.

Lifestyle changes

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) suggests that someone with type 2 diabetes may need certain lifestyle changes. This may include:

• eating nutritious meals
• limiting calories if they have excess weight
• encouraging physical activity
• quitting smoking, if applicable
• managing blood glucose, blood pressure, and cholesterol levels

Medication

A healthcare professional may prescribe blood-sugar lowering medication to a person living with T2D. The type of medication a doctor recommends will depend on several considerations, such as:

• a person’s treatment goal
• an individual’s general health
• whether a person is taking their medications
• whether someone has an underlying condition
• how well the medication works or the body tolerates it

Blood-sugar lowering medication broadly falls into two categories: oral medicines and injectable medicines.

Oral medicines may be in tablet or liquid form. Typically, people living with T2D start with medication called metformin. This drug helps the liver make less glucose and enables the body to use insulin better.

Other oral medicines work in slightly different ways to lower blood glucose levels. For example, alpha-glucosidase inhibitors, such as acarbose, work by blocking the absorption of carbohydrates by the small intestine.

A medical professional may prescribe glucagon-like peptide-1 receptor agonists. These medications work by increasing insulin production and reducing the amount of glucose the liver releases. A person may use this in conjunction with other antidiabetic medication.

In some cases, people with T2D may need insulin injections to help better manage their glucose levels. Insulin injections act as a replacement or supplement for the body’s natural insulin.

Learn about the best injection sites for insulin.

Type 2 diabetes is a health condition that may cause a person’s blood sugar levels to rise. High blood glucose levels can result in severe health complications.

As such, to help manage the condition, health experts advise that people aim to keep their blood sugar range between 80 and 130 mg/dL before a meal and under 180 mg/dL 2 hours after a meal.

A doctor can help a person develop a care plan. This will typically involve discussing how best to monitor their blood sugar and advising how to keep blood glucose within a suitable range. This may include lifestyle changes such as encouraging physical activity and quitting smoking, if applicable.

What are the blood glucose ranges for a person with type 2 diabetes?

Type 2 diabetes (T2D) is a health condition that may cause a person’s blood sugar levels to become too high. It is important to monitor blood glucose and keep it within an appropriate range to help manage the condition.

T2D occurs when a person’s body can no longer effectively use the insulin their pancreas produces. Doctors call this insulin resistance. When the pancreas cannot keep up and blood sugar rises, it sets the stage for prediabetes and T2D.

High blood sugars can damage the body and result in serious health complications, such as heart disease, vision loss, and kidney disease. It is advisable to keep blood sugar levels within suitable ranges to help prevent health problems.

For individuals with T2D, health experts recommend aiming to keep blood sugars between 80 and 130 milligrams per deciliter (mg/dL) before a meal and less than 180 mg/dL 2 hours after.

In this article, we will discuss suitable ranges for blood sugars and how to monitor blood glucose.

Health experts advise that a person living with T2D should aim to keep their blood glucose range between 80 and 130 mg/dL before a meal and less than 180 mg/dL 2 hours after.

As part of routine diabetes management, a person will often also require an A1C test. This is a blood test that a healthcare professional performs to provide information on a person’s average blood glucose levels over the past 3 months.

Depending on a person’s diabetes history and general health, they may have different A1C targets. However, research suggests that someone can reduce the risks of diabetes complications by maintaining an A1C of 7% or below.

Learn more about managing and lowering A1C levels.

Glucose goals vary from person to person. Someone living with T2D can regularly discuss managing diabetes with a doctor.

During this process, a health professional will adapt a person’s care plan, including their glucose ranges. The target ranges may vary depending on several factors. These can include age or any additional health issues an individual may have.

There are two main ways a person can self-check their glucose levels.

The first is via a finger-prick test. This involves placing a test strip in a meter, then using a needle to prick the person’s finger. This will draw a small amount of blood that a healthcare professional can test. By placing blood on the test strip, the meter can provide a glucose reading.

The second method is through continuous glucose monitoring (CGM). This involves wearing a sensor, which a person can scan with a small device or smartphone. Alternatively, the sensor can link with a smart device and send data to it independently. Unlike finger-pricking, CGMs do not measure glucose in the blood. Instead, it measures interstitial fluid, which refers to the amount of glucose in the fluid surrounding a person’s cells.

When living with T2D, there are several regime related activities a person needs to do to manage the condition. A medical professional will typically work with individuals to help develop a care plan. This may involve making lifestyle changes and taking prescribed medications.

Managing blood glucose may vary depending on several factors, such as whether a person has obesity, their age, and if they have any underlying conditions.

Lifestyle changes

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) suggests that someone with type 2 diabetes may need certain lifestyle changes. This may include:

• eating nutritious meals
• limiting calories if they have excess weight
• encouraging physical activity
• quitting smoking, if applicable
• managing blood glucose, blood pressure, and cholesterol levels

Medication

A healthcare professional may prescribe blood-sugar lowering medication to a person living with T2D. The type of medication a doctor recommends will depend on several considerations, such as:

• a person’s treatment goal
• an individual’s general health
• whether a person is taking their medications
• whether someone has an underlying condition
• how well the medication works or the body tolerates it

Blood-sugar lowering medication broadly falls into two categories: oral medicines and injectable medicines.

Oral medicines may be in tablet or liquid form. Typically, people living with T2D start with medication called metformin. This drug helps the liver make less glucose and enables the body to use insulin better.

Other oral medicines work in slightly different ways to lower blood glucose levels. For example, alpha-glucosidase inhibitors, such as acarbose, work by blocking the absorption of carbohydrates by the small intestine.

A medical professional may prescribe glucagon-like peptide-1 receptor agonists. These medications work by increasing insulin production and reducing the amount of glucose the liver releases. A person may use this in conjunction with other antidiabetic medication.

In some cases, people with T2D may need insulin injections to help better manage their glucose levels. Insulin injections act as a replacement or supplement for the body’s natural insulin.

Learn about the best injection sites for insulin.

Type 2 diabetes is a health condition that may cause a person’s blood sugar levels to rise. High blood glucose levels can result in severe health complications.

As such, to help manage the condition, health experts advise that people aim to keep their blood sugar range between 80 and 130 mg/dL before a meal and under 180 mg/dL 2 hours after a meal.

A doctor can help a person develop a care plan. This will typically involve discussing how best to monitor their blood sugar and advising how to keep blood glucose within a suitable range. This may include lifestyle changes such as encouraging physical activity and quitting smoking, if applicable.

Tablet preparations in the treatment of type II diabetes mellitus

Tablets in the treatment of type II diabetes mellitus

Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from impaired insulin secretion, insulin action, or both. To date, the incidence of DM is growing catastrophically in all countries of the world without exception, acquiring the scale of a worldwide epidemic. In 2000 In the world there were more than 160 million patients, and it is expected that by 2010. their number will exceed 215 million. There were more than 2 million patients with diabetes, of which about 1.775 million suffered from type II diabetes.

Type II diabetes is based on both insulin resistance and impaired insulin secretion. Type II diabetes (primarily insulin resistance) is an integral part of the so-called metabolic syndrome, which is visceral obesity, dyslipidemia (increased TG, LDL-C, decreased HDL-C), arterial hypertension. Metabolic syndrome and type II diabetes, as one of its manifestations, are the leading causes of death in the developed countries of Europe and North America. Moreover, at 90s In the last century, mortality from type II diabetes has steadily increased. One of the features of type II diabetes is a long-term asymptomatic course. In the early stages of the disease, hyperglycemia contributes both to the development of severe disorders of insulin secretion and the rapid progression of atherosclerosis and damage to the nervous system. The absence of clinical symptoms of a moderate (up to 7-10 mmol / l and above) increase in glycemia leads to a low rate of patients seeking medical attention, creates the illusion of apparent well-being. All this leads to the fact that at the time of detection of type II diabetes (usually accidental), patients already have complications of the disease in the form of visual impairment (retinopathy), kidney damage (micro-, macroproteinuria), damage to the vessels of the heart, brain, and lower extremities. The above complications are the main cause of death and high disability in patients with type II diabetes.

At present, the pathogenesis of complications of type 2 diabetes has been determined in the framework of international multicenter prospective clinical studies (DECODE, UKPDS, Helsinki Policemen Study, Kumamoto Study, etc.) and on laboratory models. The development of diabetes complications is based on insulin resistance, compensatory hyperinsulinemia and hyperglycemia, which primarily develops after eating. The development of type II diabetes undergoes a series of successive stages, the final of which is a persistent decrease in insulin secretion (Fig.). In this regard, one of the main tasks of type II diabetes therapy is to maintain not only normoglycemia, but also to preserve the reserve capacity of pancreatic beta-cells (PJ). Since carbohydrate metabolism disorders are not the only manifestations of DM, and hyperglycemia and insulin resistance lead to disruption of all types of metabolism, DM compensation is carried out in several directions.

The primary and most important task in the treatment of type II diabetes is the normalization of glycemia. The largest prospective clinical study UKPDS (United Kingdom Prospective Diabetes Study) has convincingly shown that the normalization (reduction) of glycemia prevents or delays the development of all complications of type II diabetes. A 1% decrease in HbA1c levels leads to a decrease in overall mortality by 21%, cardiovascular morbidity by 14%, and microcirculatory disorders by 37%. At the same time, the risk of death in type II diabetes is reduced by 42 and 63% with a decrease in HbA1c by 2 and 3%, respectively. The other largest study, DECODE (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe), showed that postprandial glucose levels of 11 mol/l (10. 0 mmol/l in venous whole blood) increase the risk of cardiovascular mortality by 2 and more times, regardless of the level of fasting glycemia.

To date, the doctor has all the possibilities of influencing the mechanisms of development of hyperglycemia in type II diabetes.

Diet and exercise are important components in treatment. The role of diet and increased exercise has proven to be effective in preventing type 2 diabetes. According to the DPP (Diabetes Prevention Program), active lifestyle changes in people with impaired glucose tolerance (IGT) led to a decrease in the development of type II diabetes by 58%. At the same time, in the later stages of type II diabetes, lifestyle modification does not lead to the complete elimination of hyperglycemia. Thus, in the above UKPDS study, only 6% of patients on diet therapy were able to achieve acceptable HbA1c levels (7%) over an 8-year follow-up period. Moreover, the epidemiological, clinical and laboratory observations available today show that the achievement of glycemic targets in type II diabetes should begin as quickly as possible from the moment type II diabetes is detected. In the vast majority of cases, this requires medical therapy.

All hypoglycemic therapy for type II diabetes can be conditionally divided into four groups:

• Drugs that have a pronounced effect on the elimination of inulin resistance (metformin, thiazolidinediones (glitazones).
• Drugs that predominantly have a direct effect on pancreatic beta cells (secretogogues), resulting in increased insulin secretion. Drugs in this group are usually used to normalize glucose levels after meals.
• Drugs that reduce the flow of carbohydrates from the intestines into the blood (acarbose, guar gum and partly metformin). The drugs of this group have an effect on glycemia after eating, however, unlike secretogogues, they do not cause an increase in insulin secretion.
• Insulin and insulin-like preparations (analogues).

Drugs that eliminate insulin resistance

The most well-known representative of this group, which has long been used in clinical practice, is metformin, which belongs to the group of biguanides. In the past few years, a new group of drugs, thiazolidinediones, has appeared in the doctor’s arsenal.

Biguanides . After the cessation of clinical use of buformin and phenformin, metformin remained the only drug of this group in the treatment of type II diabetes. The safety of metformin in comparison with other biguanides is explained by a different chemical structure, which reduces the blocking of electron transfer through cell membranes and reduces the risk of developing lactic acidosis.

Metformin has been used in the treatment of type 2 diabetes since 1957, and a vast clinical experience and scientific material associated with its use has now been accumulated. The main action of metformin can be defined as antihyperglycemic rather than hypoglycemic. It has now been proven that the drug reduces glucose production by liver cells, increases glucose utilization by peripheral tissues (primarily muscles) and reduces postprandial glycemia by activating anaerobic glycolysis in the small intestine and slowing down intestinal absorption.

The drug does not affect the beta cells of the pancreas, does not increase insulin secretion, therefore, does not cause hypoglycemia.

One of the most important mechanisms for the development of hyperglycemia in type II diabetes is an increase in hepatic glucose production at night and early morning hours, which leads to an increase in fasting blood glucose. Metformin effectively eliminates this defect.

Before the advent of glitazones, biguanides were the main drugs that acted on insulin resistance. The basis of insulin resistance in type II DM is a violation of the mechanisms of the post-receptor action of insulin, i.e. the sensitivity of various organs and tissues to the effects of insulin decreases. Metformin affects this process, which in turn leads to a decrease in peripheral insulin resistance, normalization of metabolism and glucose uptake by muscles, liver and adipose tissue, prevents the development of hyperglycemia and late complications of type II diabetes.

Other beneficial effects include reduced absorption of carbohydrates in the intestines, reduced appetite with metformin, which contributes to weight loss in patients with diabetes and obesity.

Metformin actively influences the process of fat metabolism, it reduces the level of TG (up to 30-45%), FFA (by 10-17%), slows down the processes of lipolysis.

The clinical and metabolic effects of metformin have been strongly supported by the UKPDS and other studies (Table 1).

Moreover, the ongoing DPP Type II Diabetes Prevention Study found a 31% reduction in disease progression in the 850 mg/day metformin group.

Metformin is the drug of choice for type II diabetes in people with overweight or abdominal obesity. Treatment with the drug begins with taking 500 mg at dinner or at night, the maximum dose can be 2.5-3 g / day (in divided doses). In the UKPDS study, conducted on the original drug of metformin – glucophage, it was reliably proven that the greatest effectiveness of the drug in preventing the development of complications of type II diabetes is achieved at an average daily dose of 2500 mg. Glucophage is currently on the market at a dosage of 1000 mg. This will help doctors optimize treatment, and patients – to simplify the use of the drug.

Due to the accumulation of lactate while taking metformin, the drug is not recommended for severe cardiovascular pathology, in patients with hypoxia of any etiology, and with impaired liver function. Following these recommendations has led to the fact that in recent years there have been no cases of fatal lactic acidosis. The frequency of lactic acidosis when taking metformin is on average 0.03 cases per 1 thousand patient-years. All cases of lactic acidosis over the past 10 years during metformin therapy are associated with a violation of the rules for taking the drug. It should be remembered that in elderly patients it is possible to reduce the therapeutic dose of the drug due to a decrease in kidney function.

Thus, metformin is the drug of choice for normalizing fasting glycemia. In the absence of its effectiveness or the presence of contraindications (hypoxia of any etiology, liver disease, pregnancy), to maintain fasting glycemia, insulins of medium duration are prescribed at night at a dose of 0. 1-0.15 U/kg, followed by correction. Monotherapy with metformin can be used with good efficiency even with a slight (up to 7.5-9.0 mmol / l) excess of postprandial (2-hour) glycemia in patients with diet therapy. At high values ​​of glycemia, the targets, as a rule, are not achieved, and it is advisable to use drugs that increase insulin secretion (secretogogues).

Thiazolidinediones (glitazones) are a group of drugs that are peroxisome proliferator-activated receptor gamma agonists (PPAR-gamma). The action of glitazones is based on the activation of glucose and lipid metabolism, mainly in muscle and adipose tissue, which leads to an increase in the activity of endogenous insulin, i.e. elimination of insulin resistance (insulin sensitizers). The drugs of this group are the most active in correcting dyslipidemia in type II diabetes due to their action in the liver and adipose tissue. To date, due to the above properties, glitazones are one of the most promising drugs in the treatment of type II diabetes. However, this group of drugs has a very short period of clinical observation (from 1998 in the USA and since 2000 . in Europe), so far there is no large-scale, long-term, completed prospective clinical trial in evidence-based medicine that has confirmed a long-term clinical and good prognostic effect. The vast majority of drugs in this group are used in North America, their prevalence in Europe does not reach 5% of the total.

Both main representatives of this group, rosiglitazone and pioglitazone, are registered in Russia. Both drugs are usually taken once in the morning (rosiglitazone can be used twice a day). The drugs are practically not excreted through the kidneys, and therefore they can be prescribed for impaired renal function, the pharmacokinetics are stable and do not require dose adjustment in the elderly. Contraindications to the appointment are elevated (2.5 or more times) hepatic transaminases.

Insulin secretagogues

This group of drugs includes sulfonylurea derivatives and glinides.

Glinides is a group of drugs that has entered practical healthcare since the mid-1990s. Two drugs are registered in our country – repaglinide (a derivative of benzoic acid) and nateglinide (a derivative of D-phenylalanine). In terms of their pharmacokinetic properties, both drugs are similar, they are distinguished by a rapid and reversible interaction with the sulfonylurea receptor. This results in a rapid and short-lived effect that mimics the first phase of insulin secretion during a meal. Features of pharmacokinetics require the appointment of drugs of this group before the main meals for 5-10 minutes. When taking the drug during meals, the rate of its absorption decreases, which is manifested by a weaker hypoglycemic effect.

Sulfonylureas have been used in the treatment of type 2 diabetes since the late 1950s, currently 2nd generation drugs are being used.

The drugs included in this group have different affinities for the receptor, different duration of action. After cloning of ATP-dependent K + channels in the mid-90s. of the last century, the question of the selectivity of a number of drugs of this group in relation to beta-cells of the pancreas is actively discussed. The time of interaction with the receptor, selectivity determine their pharmacokinetics.

According to the main properties, drugs can be divided into the following groups: those with a daily spectrum of action (glimepiride, gliclazide MB), low risk of hypoglycemia and cardiotoxic effect (gliclazide, glimepiride), maximum hypoglycemic effect (glibenclamide, glimepiride), as well as drugs, the use of which possible in chronic renal failure (gliquidone, gliclazide).

Various representatives of this group were analyzed from the perspective of evidence-based medicine in the framework of large-scale prospective studies. Of all drugs, the greatest experience has been accumulated with respect to glibenclamide (Table 2).

Appointment of secretogogues in type II diabetes has the main goal of normalizing the absorption of post-absorption glucose. In the vast majority of cases, with type II diabetes, against the background of diet therapy and the use of secretogogues, it is possible to achieve glycemia after meals up to 7.5-8.0 mmol / l. Metformin, thiazolidinediones, or acarbose may be added to treatment if postprandial glycemic targets are not achieved. If the combination is ineffective, it is advisable to add insulin therapy.

Patients with type 2 diabetes are forced to receive a large number of medications to achieve the goals of treatment, prevention or treatment of late complications. Taking a large number of drugs leads to low compliance of patients. Patients are reluctant to follow the recommendations, skip taking medications. One of the trends in the treatment of such patients is the introduction to the market of combined drugs that can affect different parts of the pathogenesis, for example, the combination of glibenclamide with metformin. The use of combined drugs allows you to influence both fasting and prandial glycemia. It is interesting that the combination therapy with glibenclamide and metformin in one preparation significantly improved the effectiveness of treatment not only in comparison with monotherapy, but also with separate administration of these drugs in equivalent doses.

Alpha-glucosidase blockers

Acarbose is a representative of this group of drugs in Russia. The drug competitively inhibits alpha-glucosidase, slows down the absorption of carbohydrates and reduces the level of glycemia after meals. The proportion of prescriptions for acarbose in the treatment of type II diabetes and its effectiveness are relatively small compared to secretogogues. At the same time, the drug showed good efficacy in preventing the development of type II diabetes in individuals with IGT. Appointment of acarbose to patients with IGT for 3 years reduced the risk of developing type II diabetes by 25%, and carbohydrate tolerance normalized in almost 1/3 of patients (STOP-NIDDM Trial).

Summarizing the above, it should be noted that in the arsenal of a practical doctor today there are all the possibilities to effectively influence hyperglycemia in type II diabetes; treatment should be started as soon as possible to achieve targets for both carbohydrate metabolism (HbA1c-glycemia), and blood pressure and lipid spectrum. Only a combined effect on the mechanisms of development of complications of type II diabetes will improve the prognosis of patients, reduce mortality and complications.

The number of patients with diabetes in the world by 2030 may grow to 643 million » Medvestnik

The number of new cases of diabetes in Russia and in the world is growing. According to 2021 data, 537 million adults on the planet live with diabetes, this is one in ten. In 2021, diabetes caused 6.7 million deaths. If this trend continues, then official forecasts promise an increase in the number of people with this diagnosis in the world to 643 million by 2030 and to 783 million people by 2045. ¹ . In Russia, in 2021, 7.4 million adults were diagnosed with diabetes, for the period from 2021 to 2022, the increase in patients with diabetes was 15%. ²

Risk factors

The risk factors for developing diabetes are well known. These are overweight, obesity, family history and heredity, habitually low physical activity; gestational diabetes mellitus or the birth of a large fetus for women, arterial hypertension, elevated levels of “bad” cholesterol – low-density lipids (LDL) or triglycerides, low levels of “good” cholesterol – high-density lipids (HDL), the presence of cardiovascular disease (CVD) ). ³

Some of these risk factors are modifiable and can be reduced or eliminated altogether, emphasized the endocrinologist, head. Endocrinological Department of the NCC of Endocrinology of the St. Petersburg State Medical University named after A.I. acad. IP Pavlova Anna Lisker . “In the first place in all clinical recommendations, both Russian and foreign, are lifestyle modification, control of carbohydrate metabolism, blood pressure and reduction of cardiovascular risk factors, ³ ,” she noted. — The recommendations of the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD) repeat the same simple truths: ⁴ lifestyle modification; management of glycemia, blood pressure, lipids, cardio risks, cardiorenal protection, which has already firmly entered our lives. And, of course, weight management plays an important role.”

In 2010, the American Heart Association (AHA) introduced the concept of cardiovascular health, which today includes 8 components. ⁵ These include diagnostic indicators (cholesterol, body mass index (BMI), blood pressure, glucose levels) and behavioral factors that we can influence: sleep, nutrition, physical activity and, importantly, smoking.

“High BMI, high fasting plasma glucose and smoking have been among the main risk factors for disability in our patients over the past 30 years”, ⁶ — stated Anna Lisker.

Nutrition advice

Harm reduction has been developed to modify lifestyle and reduce exposure to risk factors. This modern strategy is now used in medicine with the aim of minimizing the harm to an individual or society as a result of dangerous actions or behavior that cannot be completely eliminated or prevented. SWR can be used to minimize risks in a group of patients who are not ready to drastically change their lifestyle and completely eliminate their risks, that is, switch to full-fledged physical activity, proper nutrition, and quit smoking. Even if the doctor motivates the patient to change something, the effect of slipping often occurs later if the patient does not visit the doctor again and does not receive a second recommendation.

Dietary advice is a mandatory part of the therapeutic plan for all patients with diabetes. Proper nutrition for a diabetic is by no means a diet, but a necessary lifestyle with formed eating habits and taking into account the individual characteristics of the patient.

Modern physicians often choose an individual diet plan for the patient or, in addition to general recommendations, individually exclude certain foods. Severe dietary restrictions are often difficult to implement, Anna Lisker noted, and the patient at some point “breaks down” from following the recommendations, gains weight even more, complicating the course of the disease. Therefore, rigid dietary recommendations are now rarely applied. Instead, it is necessary to form a nutrition style, calculate and reduce the caloric content of the diet based on an individual approach. Standard recommendations for patients with diabetes are formed in the concept of a “traffic light”: green light – foods that can be eaten without restriction, yellow – what should be limited, and red – what should be excluded as much as possible. ⁷

Salt, sugar and fat in foods and drinks are individual risk factors that can be excluded for the patient. Measures are now being taken in the Russian Federation to regulate the content of salt, sugar and fat in foodstuffs. The Federal Law of the Russian Federation “On the Quality and Safety of Food Products”, as amended in 2022 ⁸ , includes a paragraph on the presence in the daily diet of foods with a reduced content of saturated fats, simple sugars and table salt. Decree of the President of the Russian Federation “On Approval of the Doctrine of Food Security of the Russian Federation” ⁹ aims to form a healthy type of nutrition, with the expansion of the range and volume of production of food products with a reduced content of fat, saturated fatty acids, sugar and table salt.

Uniform sanitary-epidemiological and hygienic requirements for products have been adopted, ¹⁰ establishing norms for fats, salt, sugar and substitutes in food products. In the country, at the state level, work is underway to modify the lifestyle of citizens. A new Russian project of voluntary marking “Svetofor”, ¹¹ which offers color labeling of foods for fat, saturated fatty acids, trans fat, sodium and sugar content: green – a small amount, yellow – quite a lot, red – a lot. From July 2023, it is planned to introduce an excise tax on sugary drinks in the Russian Federation, so that drinks with a lower content of carbohydrates and sugar are a priority for consumers. ¹²

Smoking cessation

Smoking is one of the main risk factors for patients with type 2 diabetes (T2DM). The relationship between smoking and the risk of developing DM has been studied in detail. According to many studies, active smokers have a 30-40% higher risk of developing diabetes compared to non-smokers. And the higher the intensity of smoking, the higher the risk, ¹³ Anna Lisker underlined. Smoking is a leading factor in the development of cardiovascular and vascular problems, diseases of the arteries of the lower extremities. Atherosclerosis of peripheral arteries is one of the severe complications for patients with diabetes, leading to disability. ¹⁴ Often a patient comes to the clinic with advanced diabetic foot syndrome, advanced arterial disease. As a result, operations on the lower extremities, often amputations, have to be resorted to, which make diabetic patients disabled. The factor of smoking in CVD, especially in the presence of DM, significantly increases the risk of acute cardiovascular events.

Smoking is an extremely serious problem, especially for a patient with DM who needs to give up cigarettes and is already limited by the doctor’s recommendations in other pleasures – food and sweets. Harmful substances that are released during the combustion of tobacco affect various structures of the body: systemic, molecular, cause endothelial dysfunction, disrupt lipid and glucose metabolism, increase glucose toxicity, systemically provoke inflammation and tissue damage, and, indirectly, further reduce insulin secretion. Initially, insulin resistance may develop, then insulinopenia may develop. ¹⁵ And all this happens when smoking tobacco, emphasizes Anna Lisker.

Complete and immediate cessation of smoking is the “gold standard”. But it is necessary to choose a strategy for the patient individually, as in the case of nutrition, Anna Lisker believes. For some, it is possible to refuse immediately and forever. Someone will be able to do it gradually. If a patient is unable or unwilling to quit smoking immediately, reduced risk products may be recommended as a transitional step. For example, modern electronic tobacco heating systems (ECHTS), which significantly reduce the risks of exposure that a regular cigarette has. ¹⁶ ESNT work on the principle of heating, eliminate the burning of tobacco, protecting people and others from cigarette smoke and reducing the intake of hazardous combustion products and carcinogenic tar into the body by up to 90%. ¹⁷

The patient’s motivation is important in quitting smoking, Anna Lisker is convinced. Patients with type 2 diabetes are most often obese or overweight, high blood pressure. Quitting smoking even with a high BMI after six months can lower blood pressure numbers, help stabilize glucose levels and blood lipids – cholesterol. After a year of giving up cigarettes in patients with DM2, there is an improvement in kidney function, a regression of metabolic side effects. ¹⁸

Smoking cessation is recommended and necessary even if there is a risk of weight gain, as weight gain does not reduce the benefits of smoking cessation, states the European Society of Cardiology (ESC) guidelines. ¹⁹ In an 8-year Oxford University study, patients who quit smoking while gaining some weight still experienced a high 67% reduction in heart attack risk and a 25% reduction in stroke risk. These patients had almost comparable benefit in reducing risk factors for heart attack and stroke compared with never smokers. ²⁰ Even more so nowadays, doctors can give the patient individual recommendations so that when quitting smoking, the weight remains stable or decreases if necessary.

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