OverviewDiabetes Type 2 is a disease which is based on both the presence of insulin resistance (insensitivity of cells to the effects of the hormone), and a violation of its secretion by cells of the pancreas. The mainstay of treatment in the early stages of the disease is adherence to a rigid diet and maintaining a healthy lifestyle with regular physical activity. However, after several months of the onset pharmacological treatment of the disease is usually required for most patients. Depending on the severity of the disease are used to treat hypoglycemic agents or insulin. Selection of treatment is carried out under the control of blood tests. Treatment of diabetes requires a thorough implementation of all recommendations of the physician and the maintenance of a healthy lifestyle.
The tactics of treatmentModern therapy of type 2 diabetes pursues the following objectives:
- Stimulation of insulin secretion;
- Reduction of insulin resistance of tissues;
- Inhibition of the synthesis of glucose and slowing its absorption from the intestine into the blood;
- Correction of dyslipidemia (disorders of lipid fractions in the ratio of the blood).
Treatment usually begins with monotherapy (one drug), then move on to combination treatment and failure to treatment with insulin.
The main groups of drugsThe choice of antidiabetic drugs are now large enough. Treatment is adjusted depending on disease severity and presence of complications.
Typically, the doctor will recommend you to regular inspections and monitoring of laboratory parameters. Not a small role played by the methods of self-control. Before application of prescribed drugs should always check with your doctor how often to measure blood sugar.
Let us examine the main groups of drugs.
1) The derivatives of sulfonylurea (glyburide, glimepiride, tolbutamide, chlorpropamide, etc.). In clinical practice, this group of drugs used from the mid 50s of last century and are the most widely used tools. Exert a dual effect, on the one hand stimulating insulin secretion by cells of the pancreas, on the other - reducing the resistance to the hormone in peripheral tissues. Sulfonylureas are well tolerated, but in some cases, can cause hypoglycemia (pronounced reduction in the concentration of glucose in the blood).
2) Biguanides (metformin). Metformin is the only representative of the biguanide class used in the present, has the effect by increasing the sensitivity of peripheral tissues (such as liver, adipose and muscle tissue) to insulin. In patients receiving metformin reduced the need for insulin secretion, which leads to weight loss, improved lipid profile and blood rheology. However, in some patients the drug may cause lactic acidosis and gastrointestinal disorders, which makes it hard to bear.
3) Derivative thiazolidinone (troglitazone, rosiglitazone). By increasing the activity of insulin receptors reduces glucose levels and normalize the lipid profile.
4) Inhibitors of alpha glucosidases (acarbose and miglitol). Work by malabsorption of carbohydrates in the gastrointestinal tract, thereby reducing hyperglycemia and insulin requirements associated with food intake.
5) Inhibitors of dipeptidyl peptidase 4 (sitagliptin, vildaglipti). Drugs cause an increase in the sensitivity of betta-cells of the pancreas to glucose, resulting in improved glucose-dependent insulin secretion..
6) Incretins such as glucagon-like peptide-1 (GLP-1), enhance glucose-dependent insulin secretion, improve the function of beta cells, suppresses inappropriately increased secretion of glucagon.
Combination therapy involves the use of two or more glucose-lowering drugs simultaneously. Typically, this type of treatment causes fewer complications than monotherapy with high doses of a single drug, improves glycemic control and delay the need for insulin therapy adherence.