Blood Glucose Management for Type 2 Diabetes Reviewed

Specific key clinical recommendations, and their accompanying level of evidence rating, are as follows:

• Patients with impaired glucose tolerance should receive counseling and education regarding weight loss and physical activity (level of evidence, A).
• In patients with type 2 diabetes, the only medication proven to reduce mortality rates is metformin (level of evidence, A).
• Acarbose appears to be associated with a lower risk for CVD events (level of evidence, B).
• Oral agents should be continued initially when insulin is added to a regimen of oral medication. Long-acting insulin should be used at first, with initial dosage usually 10 units/day or 0.17 to 0.5 units/kg/day, and it should be titrated in increments of 2 units approximately every 3 days (level of evidence, C).

Metformin, a biguanide, is considered a first-line agent and has been shown to reduce progression from glucose intolerance to type 2 diabetes and to reduce mortality rates in patients with type 2 diabetes. The mechanisms of action of metformin are to decrease hepatic glucose output and sensitize peripheral tissues to insulin. To prevent 1 case of type 2 diabetes, the number needed to treat with metformin is 13.9.

Am Fam Physician. 2009;79:29-36.