An algorithm for the treatment of type 2 diabetes in Latin America

Abstract

Diabetes is a principal and growing health concern in Latin America, accounting for significant mortality and morbidities. Large, randomized, prospective trials of various interventional therapies in patients with both type 1 and type 2 diabetes have demonstrated that reductions in hyperglycaemia and management of diabetes-related risk factors can significantly reduce the micro- and macrovascular complications of diabetes. Therefore, patients with type 2 diabetes will benefit from more aggressive treatment regimens to help decrease the occurrence and rate of progression of diabetic complications. Given the many complexities of diabetes management, it is often difficult for general practice physicians to stay abreast of emerging treatment strategies and therapies. Owing to the high prevalence of type 2 diabetes in Latin America, the majority of patients with diabetes are treated by generalists rather than specialists. This article was intended to assist physicians and other healthcare professionals in developing and using effective treatment strategies to stem the growing epidemic of diabetes and its complications in Latin America.

Treatment Algorithms and the Pharmacological Management of Type 2 Diabetes

“…Reports in the literature suggest that well-defined protocols for the use of oral agents in the management of diabetes would produce better results, 1,[6][7][8][9][10] and the experience of our DMP concurs with these reports.…”

“…With respect to microvascular complications, ~ 16-21% of patients with diabetes experience retinopathy, 12-23% nephropathy, and 20-40% neuropathy. 1 The risk of macrovascular complications, such as cardiovascular disease (CVD), cerebrovascular disease, and peripheral vascular disease, is several times higher in patients with type 2 diabetes than in nondiabetic patients.…”

“…14 Some evidence suggests that the actual incidence of hypoglycemia resulting from treatment with any agent is of minor significance in comparison with the incidence of hypoglycemia associated with lifestyle changes. 1,14 Regardless, some patients will be at higher risk than others, and the relative risk should be considered.…”

Control of type 2 diabetes mellitus among general practitioners in private practice in nine countries of Latin America

“…There is ample evidence that good medical management, particularly tight glucose control, is associated with fewer long-term complications (23). Accurate and continuous glucose control has been particularly associated with the development of fewer microvascular complications (17).…”

“…Combination therapy has been shown to improve glucose control where monotherapy has proved inadequate (23).…”