New understanding of the problem of management of type 2 diabetes mellitus - novel prospects (ADA/EASD consensus, 2008)

Type 2 diabetes mellitus is a severe progressive disease associated with the high incidence of complications. The worldwide incidence of type 2 diabetes mellitus is known to be steadily growing which makes the management of this disease a topical medical problem. The majority of the patients all over the world fail to achieve recommended treatment end-points. The scientifically-sound choice of an adequate pharmacotherapeutic modality based on the available data on type 2 diabetes pathophysiology is of utmost importance under conditions of real clinical practice. The new updated ADA/EASD consensus of 2008 provides a well-grounded practical algorithm for the initiation and further adjustment of drug therapy in patients with type 2 diabetes mellitus. The HbA1c level of 7.0% or higher at any stage of the treatment should be regarded as a signal for active correction of the previous therapeutic regime. The early prescription of basal insulin contributes to the efficacious glycemic control and decreases the risk of long-term diabetic complications. Treatment with a combination of insulin and metformin is a highly effective approach to the management of patients with hyperglycemia and simultaneously slows down weight gain. The present algorithm enables clinicians to choose the most adequate hypoglycemic agents and combine different therapeutic modalities to the benefit of each individual patient.