Treatment Of Diabetes Mellitus ( T2dm )

Type 2 diabetes mellitus (T2D) is the most common form of diabetes (American Diabetes Association, 2012). T2D is so prevalent that it is estimated to be the fifth most common cause of death worldwide (Yates, Jarvis, Troughton, and JaneDavies, 2009, p. 1). T2D manifests when the body is unable to metabolize glucose properly, resulting in elevated blood sugar, debilitating fatigue, and other serious complications such as distal limb amputations, kidney failure, and blindness. The generally accepted causes of T2D include diet, sedentary lifestyle, and obesity.

Diabetes is a growing but preventable health concern in the United States.1 It is a problem in the body where blood glucose levels rise higher than normal.1 According to the facts released by the American Diabetes Association in 2013, 25.8 million Americans (8.3%) have diabetes 2 and approximately 90% of all cases of diabetes worldwide are considered type 2 diabetes.3 Type 2 diabetes is a progressive disease where the body cannot use insulin properly and the patient ends up using an oral hypoglycemic agent.1 One of the many classes of medications to help manage diabetes is sulfonylureas, including glyburide and glipizide. These drugs close K-ATP channels on Beta cell membranes and cause the pancreas to release more insulin to lower blood sugar.4 Both glipizide and glyburide are metabolized in the liver5, have high protein binding5, and can decrease hemoglobin A1c (HbA1c) up to 1%-2%.6 According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury".7 Insurance companies always strive to achieve their target glycemic goal via the most effective and cost effective therapeutic strategy.8 A literature search was conducted to find data on the benefits of converting patients from glyburide to glipizide to find out why insurance prefers the switch.

Metformin is a diabetes medicine that helps control blood sugar levels in people with type II diabetes. You will take this pill two times a day in the morning and at night to improve blood sugar control. Remember to drink a full 8-ounce glass of water when taking this medication to assure proper hydration. Your kidney health will be monitored while you take this medication.

The mainstay of type 2 diabetes medication is Metformin due to the cost, safety of the medication and limitied side effects. Metformin reduces glucose levels through two pathways; it reduces hepatic glucose production and increases the insulin tissue sensitivity. Monotherapy is normal for this medication; however, it can be utilized in combination with other medications. Metformin used in conjunction with Sodium glucose cotransporter provides a greater control over the level of glucose in the body due to the reduction of glucose production, increase in sensitivity, reduction of reabsorption of glucose and the excretion of glucose through the kidneys, basically the glucose control is through 4 different pathways making it a synergetic effect on diabetes type 2. According to Inzucchi et al.(2016), the combination of these medications helped patients reduce their overall A1c (0.5-1.0), lose weight (2kg) and a reduction in their blood

The individual used in this paper was a 56-year-old female that is pre-diabetic but is on the verge of having type 2 diabetes. The individual has been dealing with diabetes for the last 4 years. She stated that she was placed on Metformin 3 years ago to help control blood glucose levels. The individual states that she did not take her Metformin like she was suppose to and was having trouble keeping her A1C down. She stated that her primary care physician recommended she tried to control her blood glucose through diet and exercise and if she was able to do this she would be able to get of the Metformin.

Diabetes continues to be a growing problem for the United States population especially type 2 diabetes, which “accounts for about 90% to 95% of all diagnosed cases of diabetes”(Center for Disease Control and Prevention (CDC), 2014). Type 2 diabetes, formally known as adult onset diabetes, is defined as a “disorder of insulin resistance in which the cells primarily within the muscle, liver, and fat tissue do not use insulin properly. As the need for insulin rises the cells in the pancreas gradually lose the ability to produce enough hormone”(CDC, 2014). Diabetes as a whole affects about “9.3% of the US population or 29.1 million people” (American Diabetes Association (ADA), 2014; CDC, 2014). Despite the high prevalence of the disease, it is only going to continue to grow if nothing is done to correct the problem. The “United States spent an estimated $245 billion on diabetes in 2012” (ADA, 2014; CDC, 2014). This outrageous number and the drastic impact diabetes has on health should emphasis the need to reduce the diabetic population in the future.

Type 2 diabetes is considered as the most common form of diabetes affecting many individuals. This is a condition that is associated with a high buildup of sugar content in the blood stream. It is accompanied by symptoms such as constant hunger, fatigue, lack of energy and frequent urination. At milder levels, the symptoms become severe and lead to the death of an individual. In the United States, it has been rated as one of the leading causes of death. Importantly, it also increases the rate of the cardiovascular disease once an individual has been reported to have such symptoms. The cardiovascular diseases lead to a greater rate of complications in patients with type two diabetes and hence loss of life. Due to this reason, researchers have focused more on the development of appropriate drugs to enhance treatment of the condition. Importantly, the fact that it is a big challenge to the medical sector critical evaluation of all possible types of treatment is vital. Therefore, the article on “semaglutide and cardiovascular outcomes in patients with type 2 diabetes” offers beneficial knowledge to the healthcare sector.

One of the most common diseases today is one that can be found in any country, and affect anyone, regardless of age, sex, race or gender. Type two diabetes mellitus affects millions of people every single day, and the majority of these millions of people will turn to medication for treatment. However, there are certain choices that can be made and actions that can be taken that will allow these individuals to obtain treatment naturally. After reading the following text, the reader will have a better understanding of how proper nutrition, exercise, and a healthy body weight will aid in the treatment of type two

Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. Retrieved from: http://www.nejm.org/doi/full/10.1056/nejmoa012512

For many type 2 diabetic patients, lifestyle modifications with a combination of metformin is not effective. For improved individualized HbA1c targets, a combination of metformin and a secondary therapy is recommended. (5) Although this therapy is recommended, many healthcare providers recommend patients to use a dual or triple oral therapy before choosing to use injectable basal insulin and a GLP-1 in order to reach the desired individualized targets.

Oral medications along with healthy eating and exercise is prescribed to patients who suffer from this disease. According to the National Institute of Diabetes and Digestive and Kidney Diseases (2017) most people start their treatment with metformin pills, which come in as a liquid form tablet. Metformin is an oral medication that helps decrease the amount of glucose a person absorbs after eating and it also helps decrease the amount of glucose the liver produces (MedlinePlus, 2017). It is vital to decrease the amount of glucose in the body so that the patient will not develop hyperglycemia. In addition, metformin increases the body’s response to insulin meaning that cell receptors can use insulin and control the amount of glucose in the body (MedlinePlus, 2017). Another medication that is prescribe is SGLT-2, which blocks glucose reabsorption in the kidneys (Diabetes.co.uk, 2017). Therefore, this can help the kidney

Diabetes is an endocrine disorder characterized by elevated glucose due to insulin resistance or deficiency. About 29.1 million people in America are reported to have diabetes with the highest prevalence occurring in men; about 25.9% of adults 65 years and older have diabetes.1 Type 2 diabetes (T2DM) is the most common type of diabetes, often due to insulin resistance. Metformin is the treatment of choice in patients with T2DM, a second agent such as a sulfonylurea is added to metformin in patients who are not at goal or unable to tolerate metformin therapy. According to the American Diabetes Association (ADA) guidelines, the choice of a second agent should be based on a patient-centered approach to include efficacy, safety, the effect on

Dapagliflozin is a relatively new and potent SGLT2 inhibitor which has shown cardiovascular safety and added cardiovascular benefits. Dapagliflozin apart from improving glycemic control also has blood pressure lowering and weight reducing effect, hence beneficial in metabolic syndrome. As monotherapy, in patients who are intolerant to metformin, it has shown to be as effective as metformin. However it is not cost effective as compared to other anti-diabetics.

Canagliflozin inhibits the sodium-glucose co-transporter 2 (SGLT2. It also glucose to be filtered through the kidney and excreted through urine. Being that the glucose is excreted through urine rather than taken into the bloodstream, it helps to lower blood sugar levels in the blood of type 2 diabetics.

Differences in type 2 diabetes management guideline and the study settings might also be the possible reasons. For example, nearly 10% of type 2 diabetes patients with hypertension comorbidity in our set up received hydrochlorothiazide or Amilodipine while guidelines recommend the use angiotensin converting enzyme inhibitors, angiotensin recptor blockers or nondihydropyridine clacium channel blockers. This is because these class of drugs have renoprotective effect and reduce protein uria (41).The rate of ineffective drug therapy in our study is slightly lower than the study in Indonesia (42)where ineffective drug therapy was identified in 50% of the participants.