Management of Type 2 Diabetes [2007 update]

Purpose, Audience, Authors, and Acknowledgements

Studies demonstrate that morbidity due to complications of diabetes can be reduced through prevention, detection, and management.  This self-study provides practical guidance to clinicians about routine screening and prevention efforts for cardiovascular risk factors (hypertension, hyperlipidemia, tobacco use) and for microvascular disease (retinopathy, nephropathy, neuropathy.  Management of risk factors, complications, and glycemis is organized into specific care activities to be performed at each regular diabetes visit, every 3 to 6 months, and annually.  Key recommendations for care are summarized at the beginning of the guideline. 

New information in this revision: 

BP control.  Controlling blood pressure has the most impact on decreasing morbidity and mortality in patients with diabetes melitus.  Target blood pressures remain less than 135/80 mmHg.  Table 3 (new) presents a treatment algorithm for the sequential addition of medications until blood pressure is controlled. 

Statins.  Patients age 40 and older with type 2 diabetes should be on moderate doses of statins.  Even those with initial LDL-C levels under 100 mg/dL receive substantial benefit.  The UMHS preferred generic statin and its moderate dose level is simvastatin 40 mg/d.  For patients with LDL-C levels greater than 100 mg/dL on this therapy, higher doses of generic (e.g., simvastatin 80 mg) or brand name statins (e.g., atorvastatin or rosuvastatin) may be indicated.  Do not use high-dose simvastatin if patients have severe renal insufficiency. Statins are optional for patients younger than 40 given their marginal cost-effectiveness.

Blood sugar control.  Generic metformin is the preferred initial oral hypoglycemic medication for patients with a normal Glomerular Filtration Rate; Sulfonylureas (eg., glipizide, glyburide) are preferred for those with contraindications to metformin. The short-term fasting glucose goal is less than 130 mg/dL and the long-term goal is a hemoblobin A1c under 7%.  The treatment algorithm for the sequential addition of medications to achieve glycemic control has been extensively revised (Table 6). 

Eye exam.  A dilated retinal exam should be performed by an eye care specialist every 2 years if previous eye exam was normal, otherwise annually or more frequently as recommended by the eye care provider. 

Urine albumin testing.  Patients who are being treated with an Angiotensin Converting Enzyme Inhibitor (ACE-I) or an Angiotensin II Receptor Blocker (ARB) no longer require annual urine albumin testing.

This self-study activity is appropriate for primary care clinicians and other health care providers providing care for adults with type 2 diabetes.

Team Leader
	Sandeep Vijan , MD General Internal Medicine
Team Members
	Hae Mi Choe, PharmD College of Pharmacy Steven J. Bernstein, MD, MPH General Internal Medicine William H. Herman, MD Endrocinology & Metabolism Robert W. Lash, MD Endrocinology & Metabolism Martha M. Funnell, MS, RN Diabetes Research & Training Center R. Van Harrison, PhD Medical Education Denise Campbell-Scherer, MD, PhD Family Medicine
Author Disclosures
	Team Member Relationship Company Steven J. Bernstein, MD, MPH (None)   Denise Campbell-Scherer, MD, PhD (None)   Hae Mi Choe, PharmD (None) Martha M. Funnell, MS, RN Consultant Eli Lilly, Home Diagnostics Inc, Novo Nordisk R. Van Harrison, PhD (None) William H. Herman, MD Consultant Aventis Eli Lilly GlaxoSmithKline Merck Sanofi-Aventis Takeda Robert W. Lash, MD (None)   Sandeep Vijan, MD (None)

Disclaimer The University of Michigan Health System web site does not provide specific medical advice and does not endorse any medical or professional service obtained through information provided on this site or any links to this site. Use of the UMHS web site does not replace medical consultation with a qualified health or medical professional to meet the health and medical needs of you or others. While the content of the UMHS web site is frequently updated, medical information changes rapidly and therefore, some information may be out of date, and/or contain inaccuracies or typographical errors.

Privacy Statement