Therapy of diabetes mellitus
المؤلف:
Marcello Ciaccio
المصدر:
Clinical and Laboratory Medicine Textbook 2021
الجزء والصفحة:
p396
2025-10-19
90
Glycemic goals in patients with type 1 and type 2 diabetes are:
– Glycated hemoglobin <53 mmol/mol (<7%)
– Fasting and preprandial blood glucose of 70–130 mg/dL
– Postprandial blood glucose <160 mg/dL
Glycated hemoglobin represents the primary treatment target due to the close relationship between this index of glycemic control and micro- and macroangiopathic complications.
The diabetes treatment relies on a correct diet, physical activity, and, if necessary, glucose lowering drugs (insulin, oral hypoglycemic drugs).
DM1 requires therapy with exogenous insulin, due to the insulinopenia resulting from the pancreatic β-cells destruction; in DM2, on the other hand, treatment is based on life style interventions (diet and exercise), oral hypoglycemic drugs, and, in some cases, insulin. In patients with DM2, metformin is the drug of the first choice. If monotherapy cannot achieve the glycemic goal, then combination therapy with metformin associated with other molecules can be evaluated. Insulin therapy is essential when glycemic control is unsatisfactory, even in polytherapy.
In a DM1 patient, the goal is to balance and combine caloric intake with the appropriate amount of insulin; therefore, diet and blood glucose monitoring must be integrated to define the optimal insulin regimen. In addition, weight gain often associated with intensive antidiabetic treatment should be minimized.
A DM1 patient can also undergo pancreas or islets of Langerhans transplantation, which aims to reduce the need for exogenous insulin while eliminating dangerous manifestations such as hypoglycemia.
Pregnant with gestational diabetes during should has the following glycemic goals:
– Fasting blood glucose <92 mg/dL
– Blood glucose 1 h after meals <140 mg/dL
– Blood glucose 2 h after meals <120 mg/dL
– HbA1C <42 mmol/mol (<6%)
The treatment of gestational diabetes is primarily nutritional, to provide adequate maternal and fetal nutrition, adequate caloric, vitamin, and mineral intake, and optimal glycemic control without ketonuria/ketonemia. If glycemic goals are not achieved after 2 weeks of a proper diet, then insulin therapy should be instituted. Oral hypoglycemic drugs are not currently recommended in pregnancy. Immediately after the diagnosis of gestational diabetes, pregnant should self-monitor glycemia by daily measurements.
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