The guidelines for treatment of type 2 diabetes have to follow standardized treatment objectives. Each patient must have a different treatment plan based on the blood sugar level, cholesterol level, and other conditions that may exist. Each patient has to be treated differently and the treatment has to be based on the threats and advantages of the approach used. The doctor or the treating physician has to in consultation with the patient device a treatment plan and fix goals. Some patients may have severe conditions like coronary heart disease, dementia, cancer and other life limiting diseases in such cases the doctor sets less ambitious goals as the life expectancy of the patient is less. There is also a case of treating the life threatening disease before treating diabetes. Death or morbidity may be delayed by treating other diseases rather than treating diabetes type 2. Such patients have less severe targets.
Target of glycemic control has to be individualized and should factor in clinical advantages and hazards of treatment. The predicted life expectancy also has to be considered when prescribing medications. Generally the following guidelines are followed.
Young age patients: disease management with nutrition and oral therapy
Middle age patients: insulin therapy, nutrition, exercise and education of hyperglycemia and hypoglycemia.
Old age or advanced age: reduction in neurological conditions and treatment for cardiovascular conditions along with glycemic control.
Accurate indication of long-term glycemic control can be known from A1c tests. The continuous non-enzymatic glycosylation of hemoglobin throughout the lifespan of an erythrocyte forms A1c.This evaluation generates a precise measure of time-averaged blood glucose during the previous six to eight weeks. In addition to A1c to evaluate the level of glycemic control regular blood sugar tests should also be utilized. When this information is available it is possible to ascertain the need to change the medications. After looking at the particular needs and the purpose of the individual patient the frequency and timing of self-monitoring blood glucose should be prescribed.
Self-monitoring blood glucose frequently is required by those patients of type 2 diabetes that are not using insulin for keeping blood sugar under control. Regular monitoring is also required if the patient has to adjust insulin dosage during meal times. Patients using multiple insulin injections also need to perform self-monitoring of blood glucose three or more times daily.
The clinical practice guidelines treatment of type 2 diabetes aims to improve detection and control of type 2 diabetes. It helps in delaying or avoiding diabetes related complications.
It has been noted that the risk of retinopathy and myocardial infraction decreases substantially with each percentage drop in A1c reading. Almost all complications risks can be reduced if glycemic control is achieved. This has been proved by countless studies. Progression of microvascular disease also reduces with achievement of glycemic control.
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