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Review
. 2023 Sep 4;2(1):e000372.
doi: 10.1136/bmjmed-2022-000372. eCollection 2023.

Advances in the management of type 2 diabetes in adults

Rodolfo J Galindo  1   2 , Jennifer M Trujillo  3 , Cecilia C Low Wang  4 , Rozalina G McCoy  5   6
Affiliations
Review

Advances in the management of type 2 diabetes in adults

Rodolfo J Galindo et al. BMJ Med. .

Abstract

Type 2 diabetes is a chronic and progressive cardiometabolic disorder that affects more than 10% of adults worldwide and is a major cause of morbidity, mortality, disability, and high costs. Over the past decade, the pattern of management of diabetes has shifted from a predominantly glucose centric approach, focused on lowering levels of haemoglobin A1c (HbA1c), to a directed complications centric approach, aimed at preventing short term and long term complications of diabetes, and a pathogenesis centric approach, which looks at the underlying metabolic dysfunction of excess adiposity that both causes and complicates the management of diabetes. In this review, we discuss the latest advances in patient centred care for type 2 diabetes, focusing on drug and non-drug approaches to reducing the risks of complications of diabetes in adults. We also discuss the effects of social determinants of health on the management of diabetes, particularly as they affect the treatment of hyperglycaemia in type 2 diabetes.

Keywords: Ambulatory care; Diabetes mellitus; Endocrinology; Internal medicine; Metabolic diseases; Primary health care.

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Conflict of interest statement

Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: in the past 36 months, RGM received support from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Aging of the National Institutes of Health (NIH), the Patient Centered Outcomes Research Institute (PCORI), the National Center for Advancing Translational Sciences, and AARP. RGM also served as a consultant to Emmi (Wolters Kluwer) on developing patient education materials related to prediabetes and diabetes. In the past 36 months, RJG has received unrestricted research support (to Emory University) from Novo Nordisk, Dexcom, and Eli Lilly, and consulting or personal fees from Sanofi, Eli Lilly, Novo Nordisk, Boehringer-Ingelheim, Bayer, Pfizer, and Weight Watchers, all outside the scope of this work.

Figures

Figure 1
Figure 1
Shifting pattern of management of type 2 diabetes. HbA1c=haemoglobin A1c; ASCVD=atherosclerotic cardiovascular disease; CKD=chronic kidney disease; HF=heart failure; GIP=glucose dependent insulinotropic polypeptide; GLP1RA=glucagon-like peptide 1 receptor agonist; SGLT2i=sodium glucose cotransporter 2 inhibitor; SU=sulfonylurea; DPP4i=dipeptidyl peptidase 4 inhibitor. *Insulin is preferred for acute management of severe hyperglycaemia; †Thiazolidinediones improve insulin resistance
Figure 2
Figure 2
Person centred goals of treatment of type 2 diabetes
See this image and copyright information in PMC

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