Comparison Of Oral Antidiabetic Agents
In 2007, the AHRQ compared the effectiveness and safety of oral diabetes medications for adults with type 2 diabetes, with a 2011 update. The AHRQ found little evidence to support predictions as to whether a particular medication is more likely to be effective in a given patient subgroup or to cause adverse effects in a particular patient.
The AHRQ concluded that although the long-term benefits and harms of diabetes medications remain unclear, the evidence supports the use of metformin as a first-line agent. On average, monotherapy with many of the oral diabetes drugs reduces HbA1c levels by 1 percentage point , and 2-drug combination therapies reduce HbA1c about 1 percentage point more than do monotherapies.
Other AHRQ findings included the following:
Metformin decreased LDL cholesterol levels relative to pioglitazone, sulfonylureas, and DPP-4 inhibitors
Unfavorable effects on weight were greater with TZDs and sulfonylureas than with metformin
Risk of mild or moderate hypoglycemia was 4-fold higher with sulfonylureas than with metformin alone this risk was more than 5-fold higher with sulfonylureas plus metformin than with a TZD plus metformin
Risk of heart failure was higher with TZDs than with sulfonylureas
Risk of bone fractures was higher with TZDs than with metformin
Diarrhea was more common with metformin than with glitazones.
Heres How You Can Get Started:
- Work with your doctor to determine what level of physical activity you should engage in
- Figure out how much time per day you can devote to exercise
- Set fitness goalshaving clear goals can help you stay motivated
- Consider where youll start working outthe gym, in your neighborhood, in a park?
- Build different activities into your daily routine
- Start slowly and allow for recovery time
- Keep track of what you do and stay focused on your goals
- Listen to your body
Management Of Intercurrent Medical Illness
Patients with intercurrent illness become more insulin resistant because of the effects of increased counterregulatory hormones. Therefore, despite decreased nutritional intake, glycemia may worsen.
Patients on oral agents may need transient therapy with insulin to achieve adequate glycemic control. In patients who require insulin, scheduled doses of insulin, as opposed to sliding scale insulin, are far more effective in achieving glycemic control.
Metformin is a special case. If patients taking metformin have any illness that leads to dehydration or hypoperfusion, the drug should be temporarily discontinued because of a possible increased risk of lactic acidosis.
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How To Use The Record
First read the shaded bar across the page. This tells you:
- the name of the test or check-up
- how often to get the test or check-up
- what your personal goal is
Then, write down the date and results for each test or check-up you get. Take this card with you on your health carevisits. Show it to your health care team. Talk about your goals and how you are doing.
|A1C At least twice each year||My goal: ______|
Being Overweight Or Obese
You’re more likely to develop type 2 diabetes if you’re overweight or obese with a body mass index of 30 or more.
Fat around your tummy particularly increases your risk. This is because it releases chemicals that can upset the body’s cardiovascular and metabolic systems.
Measuring your waist is a quick way of assessing your diabetes risk. This is a measure of abdominal obesity, which is a particularly high-risk form of obesity.
Women have a higher risk of developing type 2 diabetes if their waist measures 80cm or more.
Asian men with a waist size of 89cm or more have a higher risk, as do white or black men with a waist size of 94cm or more.
Exercising regularly and reducing your body weight by about 5% could reduce your risk of getting diabetes by more than 50%.
Read about measuring your waist size
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Type 2 Diabetes: Which Medication Is Best For Me
- By Samar Hafida, MD, Contributor
If you are living with type 2 diabetes, you certainly are not alone. One in 10 people in the US has diabetes, according to the CDC. However, despite considerable progress in diabetes treatment over the past 20 years, fewer than half of those with diabetes actually reach their target blood sugar goal.
In part, this may be because doctors can be slow to make changes to a patients treatment plan, even when a patients treatment goals are not being met. One reason for this may be the overwhelming number of medications currently available. And yet, waiting too long to adjust treatment for type 2 diabetes can have long-lasting negative effects on the body that may raise the risk of heart and kidney disease and other complications.
Risk Factors For Type 2 Diabetes
While there are some risk factors for type 2 diabetes that are out of your control , there are certain lifestyle choices that can also put you at a greater risk of developing type 2 diabetes. Some of these include:
- Living with excess weight. When youre living with excess weight, you most likely have more fatty tissue, which can make your cells more resistant to insulin.
- Living a more sedentary lifestyle. Regular physical activity helps your cells respond better to insulin.
- Eating a lot of highly processed foods. Highly processed foods can have a lot of hidden sugar and refined carbs. If your life requires a more grab-and-go type of eating style, talk with your doctor or a dietician about nutritious swaps.
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Is One Medication Better Than Another
In recent years, many new medicines for treating type 2 diabetes have been developed.
According to international guidelines, patients should take metformin as their first-line type 2 diabetes treatment unless there is a medical reason that it should not be prescribed.
However, various factors should be taken into account when choosing a ‘second-line’ medication to add to metformin. You can find out more about the individual medicines later in this leaflet.
- If it is important to avoid low blood glucose – DPP-4 inhibitor, SGLT-2 inhibitor, pioglitazone or GLP-1 mimetic.
- For people with a history of heart attack, stroke, etc – SGLT-2 inhibitor or GLP-1 mimetic with proven heart benefit.
- For people with a history of heart failure or chronic kidney disease – SGLT-2 inhibitor or, if not suitable, GLP-1 mimetic.
- For people where weight loss or avoiding weight gain is important – SGLT-2 inhibitor or GLP-1 mimetic .
- In the UK, the National Institute for Health and Care Excellence recommends that with some exceptions, GLP-1 mimetics should only be prescribed for people with a body mass index over 35.
Take Medicines As Prescribed
Several medicines are available for people with type 2 diabetes. They work in different ways to help the body make or respond to insulin better.
Sometimes pills for diabetes even when combined with diet and exercise aren’t enough to keep blood sugar levels under control. Some people with type 2 diabetes also have to take insulin. The only way to get insulin into the body now is by injection with a needle or with an insulin pump. If someone tried to take insulin as a pill, the acids and digestive juices in the stomach and intestines would break down the medicine, and it wouldn’t work.
Getting insulin injections today is nearly painless, thanks to smaller needles. Insulin pumps cut down on the number of injections needed.
Different kinds of insulin are used for different purposes. The types of insulin you use and how you take it each day will depend on what’s best for you and your daily schedule.
If you take an insulin shot but forget to eat, your blood sugar levels can get too low. So try to avoid skipping meals or snacks. If your parents remind you to eat when you take your insulin, it’s probably because they worry about you, not because they’re trying to nag you!
Your diabetes health care team will teach you how and when to give yourself insulin.
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Learn How To Live With Diabetes
It is common to feel overwhelmed, sad, or angry when you are living with diabetes. You may know the steps you should taketo stay healthy, but have trouble sticking with your plan over time. This section has tips on how to cope with your diabetes,eat well, and be active.
Cope with your diabetes.
- Stress can raise your blood sugar. Learn ways to lower your stress. Try deep breathing, gardening, taking a walk, meditating, working on your hobby, or listening to your favorite music.
- Ask for help if you feel down. A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better.
- Make a diabetes meal plan with help from your health care team.
- Choose foods that are lower in calories, saturated fat, trans fat, sugar, and salt.
- Eat foods with more fiber, such as whole grain cereals, breads, crackers, rice, or pasta.
- Choose foods such as fruits, vegetables, whole grains, bread and cereals, and low-fat or skim milk and cheese.
- Drink water instead of juice and regular soda.
- When eating a meal, fill half of your plate with fruits and vegetables, one quarter with a lean protein, such as beans, or chicken or turkey without the skin, and one quarter with a whole grain, such as brown rice or whole wheat pasta.
Know what to do every day.
Talk to your health care team.
- Ask your doctor if you have any questions about your diabetes.
- Report any changes in your health.
Stroke Prevention In Diabetes
The 2010 American Heart Association/American Stroke Association guidelines for the primary prevention of stroke include the following recommendations for patients with diabetes:
Regular blood pressure screening
Physical activity 30 minutes or more of moderate-intensity activity on a daily basis
A low-sodium, high-potassium diet to reduce blood pressure a diet emphasizing consumption of fruits, vegetables, and low-fat dairy products may lower stroke risk
A blood pressure goal of less than 130/80 mm Hg
Drug therapy with ACE inhibitors or ARBs
Statin therapy, especially in patients with other risk factors monotherapy with fibrates may also be considered to lower stroke risk
The AHA/ASA guidelines note that the benefit of taking aspirin for the reduction of stroke risk has not been fully demonstrated in diabetic patients.
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About Type 2 Diabetes
Diabetes is usually a lifelong condition that causes a person’s blood glucose level to become too high.
The hormone insulin produced by the pancreas is responsible for controlling the amount of glucose in the blood
There are two main types of diabetes:
- type 1 where the pancreas doesn’t produce any insulin
- type 2 where the pancreas doesn’t produce enough insulin or the body’s cells don’t react to insulin
This topic is about type 2 diabetes.
Read more about type 1 diabetes
Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear after birth.
Nonsteroidal Mineralocorticoid Receptor Antagonists
In July 2021, the FDA approved finerenone for inhibition of the effects in adults of chronic kidney disease associated with type 2 diabetes, including sustained estimated glomerular filtration rate decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure. It is the first nonsteroidal mineralocorticoid receptor antagonist to be approved for this purpose. Approval was based on the FIDELIO-DKD trial, a placebo-controlled study that involved over 5700 patients with type 2 diabetes to whom the maximum-tolerated dose of renin-angiotensin system inhibitor was already being administered. However, until more data on finerenone is gathered, RASIs and SGLT-2 inhibitors will be the preferred agents for slowing chronic kidney disease in type 2 diabetes.
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Garlic Ginger Mint And Anarchy
Here, I would like to mention one of the most effective home remedies for diabetes .
To prepare it, you need:
- 100-gram Garlic
- 100-gram Anardana
Want to Buy Anardana?
You can get it from here.
All the things are easily available at home or at stores, use them fresh.
How to prepare it?
Mix all the things without adding anything else to a sauce.
Note: You can only store the sauce for 1-2 weeks after that you have to prepare a new one.
How to use?
- Take almost 200 to 250-gram yogurt and add one teaspoon of the mixture that you have prepared.
- After adding the mixture in yogurt mix it thoroughly and then eat it.
- Each day you have to repeat the process and make sure you eat it once a day.
You can consume it anytime, but it is highly recommended that you use it early in the morning without eating anything else and I guarantee you that youll see improvement day by day.
Check Blood Sugar Levels
Checking your blood sugar levels is another part of your diabetes treatment plan. It lets you know how well the other parts of your treatment plan are working, and it’s the only way to know how you are doing with your diabetes control on a daily basis.
Your care team may recommend that you use a continuous glucose monitor . A CGM is a wearable device that can measure blood sugar every few minutes around the clock. It’s measured by a thread-like sensor inserted under the skin and secured in place. The more frequent CGM blood sugar readings can help you and the care team do an even better job of troubleshooting and adjusting your insulin doses and diabetes management plan to improve blood sugar control.
A blood glucose meter or CGM tells you what your blood sugar level is at the moment. Your doctor may also send you for another type of blood sugar test called a hemoglobin A1c test . It lets you and your care team know how your blood sugar levels have been for the few months before the test.
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Joint Consensus Statement On Remission
In a 2021 joint consensus statement from the American Diabetes Association, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK, the term remission, as it applies to type 2 diabetes, is defined as the presence of an HbA1c level below 6.5% at least 3 months after glucose-lowering pharmacotherapy has been halted. This applies whether the remission has been achieved by way of lifestyle, bariatric surgery, or other means.
Monitoring Your Own Blood Glucose
If you have type 2 diabetes, as well as having your blood glucose level checked by a healthcare professional every two to six months, you may be advised to monitor your own blood glucose levels at home.
Even if you have a healthy diet and are taking tablets or using insulin therapy, exercise, illness and stress can affect your blood glucose levels.
Other factors that may affect your blood glucose levels include drinking alcohol, taking other medicines and, for women, hormonal changes during the menstrual cycle.
A blood glucose meter is a small device that measures the concentration of glucose in your blood. It can be useful for detecting high blood glucose or low blood glucose .
If blood glucose monitoring is recommended, you should be trained in how to use a blood glucose meter and what you should do if the reading is too high or too low.
Blood glucose meters aren’t currently available for free on the NHS but, in some cases, blood monitoring strips may be. Ask a member of your diabetes care team if you’re unsure.
Read about diabetic eye screening.
Advanced Glycation End Products
Food-derived, pro-oxidant, advanced glycation end products may contribute to insulin resistance in clinical type 2 diabetes mellitus and may suppress protective mechanisms. Advanced glycation end-product restriction may preserve native defenses and insulin sensitivity by maintaining a lower basal oxidative state.
The Cause Of Diabetes
Diabetes is an illness related to elevated blood sugar levels. When you stop releasing and responding to normal amounts of insulin after eating foods with carbohydrates, sugar and fats, you have diabetes. Insulin, a hormone thats broken down and transported to cells to be used as energy, is released by the pancreas to help with the storage of sugar and fats. But people with diabetes dont respond to insulin properly, which causes high blood sugar levels and diabetes symptoms.
Its important to note that theres a difference between type 1 and type 2 diabetes. Heres an explanation of the two types of diabetes and what causes these conditions:
Type 1 Diabetes
Type 1 diabetes is commonly called juvenile diabetes because it tends to develop at a younger age, typically before a person turns 20 years old. Type 1 diabetes is an autoimmune disease where the immune system attacks the insulin-producing beta cells in the pancreas.
The damage to the pancreatic cells leads to a reduced ability or complete inability to create insulin. Some of the common causes that trigger this autoimmune response may include a virus, genetically modified organisms, heavy metals, or foods like wheat, cows milk and soy.
The reason foods like wheat and cows milk have been linked to diabetes is because they contain the proteins gluten and A1 casein. These proteins can cause leaky gut, which in turn causes systemic inflammation throughout the body and over time can lead to autoimmune disease.
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Reflect On The Amount Of Sugar In Your Diet
Hyperglycemia occurs when there is too much glucose in the blood.
Therefore, one way of reducing your blood glucose levels is reflecting on where sugar may be consumed in the diet. Think about any refined and processed foods that may be in your diet as these are often high in sugar. This can be achieved through a low carbohydrate diet.