Treatment
Management of Pre-Diabetes
Treatment of pre-diabetes is very important. Research shows that lifestyle and medical interventions can help prevent, or at least delay, the progression to diabetes, as well as lower their risk for heart disease.
- The most important lifestyle treatment for people with pre-diabetes is to lose weight through diet and regular exercise. Even a modest weight loss of 10 - 15 pounds can significantly reduce the risk of progressing to diabetes.
- Patients should have an exercise goal of 30 - 60 minutes, at least 5 days a week, and follow a low-fat, high-fiber diet. Quitting smoking is also essential.
- It is also important to have your doctor check your cholesterol and blood pressure levels on a regular basis. Your doctor should also check your fasting blood glucose and microalbuminuria levels every year, and your hemoglobin A1c and lipids every 6 months.
- While doctors sometimes prescribe insulin-regulating drugs such as metformin (Glucophage) and acarbose (Precose), evidence indicates that lifestyle changes can be at least as effective as drug therapy.
Management of Type 2 Diabetes
The major treatment goals for people with type 2 diabetes are to control blood glucose levels and to treat all conditions that place patients at risk for heart disease, stroke, kidney disease, and other major complications.
Approach to controlling blood glucose levels includes:
- Achieving fasting blood glucose levels of less than 110 mg/dL and glycosylated hemoglobin (HbA1c) levels of less than 7%. (However, patients who have a history of severe hypoglycemia, vascular complications or other diseases, or longstanding diabetes may benefit from looser control of blood sugar. Patients should discuss individualized treatment goals with their doctors.)
- Close monitoring of blood sugar and hemoglobin HbA1c levels.
- Use of oral anti-hyperglycemic drugs such as metformin are first-line drug treatments, and insulin if needed.
Approach for reducing complications includes:
- Healthy lifestyle changes, such as regular exercise, heart-healthy diet, quitting smoking.
- Use of various drugs provided by your doctor to control high blood pressure (such as ACE inhibitors and diuretics), lower cholesterol (statins and fibrates), and to prevent clots, such as aspirin or clopidogrel (Plavix).
- Close follow-up with your doctor.
Glucose Goals for Patients with Diabetes
|
|
|
Normal
|
Goal
|
|
Blood glucose levels before meals
|
Less than 110 mg/dL
|
90 - 130 mg/dL for adults
100 - 180 mg/dL for children under age 6
90 - 180 mg/dL for children 6 - 12 years old
90 - 130 mg/dL for children 13 - 19 years old
|
|
Bedtime blood glucose levels
|
Less than 120 mg/dL
|
110 - 150 mg/dL for adults
110 - 200 mg/dL for children under age 6
100 - 186 mg/dL for children 6 - 12 years old
90 - 150 mg/dL for children 13 - 19 years old
|
|
Glycosylated hemoglobin (HbA1c) levels
|
4 - 6%
|
Less than 7%
|
|
Source: Standards of Medical Care In Diabetes -- 2008, American Diabetes Association.
|
Treating Special Populations
Different goals may be necessary for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions. Treating children with type 2 diabetes depends on the severity of the condition at diagnosis. Metformin is approved for children. Formerly, only insulin was approved for treating children with diabetes.
