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Feature Article

Type 2 diabetes: tailoring a treatment approach

Kharis Burns, N. Wah Cheung

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Abstract

The past decade has seen major advances in therapies for type 2 diabetes, leading to a wide array of treatment options. Management should involve a patient-centred approach with individualised glycaemic targets and selection of medications based on comorbidities, cost and patient preference.

Key Points

  • Early and optimal glycaemic control in patients with type 2 diabetes is imperative for reducing microvascular and potentially macrovascular complications.
  • Glycated haemoglobin (HbA1c) remains the key focus of glycaemic management although targets should be individualised based on age, comorbidities and life expectancy.
  • There is a vast array of therapies available and treatment algorithms provided by the Australian Diabetes Society offer guidance on treatment selection.
  • Treatment choice should be guided by patient comorbidities, adverse effect profile, acceptability of the method of administration and cost (PBS subsidy).
  • Metformin remains first-line treatment unless contraindicated. Insulin may be considered at any stage, particularly where control is poor (HbA1c above 75 mmol/mol [9%]).
  • Patients with pre-existing cardiovascular disease can be safely managed with new agents, including some DPP4-inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors, and some therapies may offer cardiovascular mortality benefit.

    Picture credit: FERTNIG/ISTOCKPHOTO.COM Model used for illustrative purposes only

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