Managing Patients With Type 2 Diabetes Poses Challenges

Balancing treatment options and medication safety can be challenging when managing patients with type 2 diabetes (T2D). T2D is considered a major cardiovascular (CV) risk factor, and the updated American Diabetes Association (ADA) guidelines reflect the need to focus on CV risk reduction. 1 Awareness of comorbidities, including established CV diseases, hypertension, and obesity, should help with selecting the best therapeutic agents to improve CV outcomes, and pharmacists can play an important role in this process. 2 There are also recent safety updates for some antihyperglycemic medications.

Guideline Updates and Pharmacotherapy
Recent CV outcomes trial data demonstrate that individuals with atherosclerotic CV disease should begin with lifestyle modifications and metformin. 1 Pharmacists should continue to recommend exercise for at least 150 minutes per week and smoking cessation. The ADA recommends the following glycemic goals for nonpregnant adults with diabetes: glycated hemoglobin (A1C), <7%; fasting plasma glucose, 80 to 130 mg/dL; and postprandial glucose, <180 mg/dL. 1 There are differences regarding A1C goals among the ADA, the American College of Physicians (ACP), and the American Association of Clinical Endocrinologists (see Figure ). 1,3,4 The ACP recommends a target A1C between 7% and 8%, which has sparked controversy with the ADA. 4,5 The ADA recommends reserving less stringent A1C goals for patients with advanced microvascular or macrovascular complications, extensive comorbid conditions, a history of severe hypoglycemia, limited life expectancy, or long-standing diabetes in which the goal is difficult to achieve. 1 Ultimately, it is always important to individualize therapy for patients to help them achieve the best outcomes. Encourage patients to perform self-monitoring of blood glucose (SMBG) to ensure appropriate pharmacotherapy and optimal T2D management. 1 Blood glucose meters record the values, making it easy for patients to take the readings to the pharmacy and physician appointments. Patients with intensive […]

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