How to obtain appropriate type 2 diabetes control in the first 180 days of treatment initiation

Type 2 diabetes is characterized by unsatisfactory levels of glycated hemoglobin (HbA_1c) for extended periods. An article published in the May 2010 edition of Postgraduate Medicine reports a proposal to shorten the total time spent with uncontrolled hyperglycemia by minimizing the number of steps along the treatment-intensification ladder. In doing so, patients would decrease their exposure to hyperglycemia and potentially improve long-term outcomes.

The authors criticize health providers for not initiating new therapies or titrating medications soon enough to reach treatment goals in a timely manner. Health care providers are keeping patients on pharmacotherapies that do not result in reaching target HbA_1c levels because of the current paradigm of treatment progression. This calls for the reevaluation of current treatment practices. The authors suggest a more timely way to measure the effectiveness of various treatments.

The authors acknowledge the importance of individualizing therapy to meet the needs and conditions of each patient, and propose that clinicians should aim to help their patients with type 2 diabetes attain optimal glycemic control within 180 days of treatment initiation. The authors seek to redefine standard management of type 2 diabetes by placing greater emphasis on the timing of treatment intensification so the time patients spend with uncontrolled hyperglycemia is reduced. This can be done by initiating combination therapy, advancing the dosages of existing agents more aggressively, and quickly adding insulin therapy. Ultimately, this will improve long-term outcomes for many patients with type 2 diabetes and help avoid future complications.

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