Summary
Pharmacological management of Type 2 diabetes requires that treatment programs and therapeutic objectives are individualized among people with the disease. The trademark metabolic anomaly associated with type 2 diabetes continues to take center stage in diabetes treatment initiatives. There have been several therapies used in other features such as hypertension and obesity that are a major focus of diabetic research on favorable therapy programs (Maureen, et.al, 2013, p. 561). Maintaining a nondiabetic range of glycemic levels has been proven to be beneficial to individuals with specific diabetic complications such as nephropathy and neuropathy in type 1 diabetes. In type 2 diabetes, experts have realized the need for more intensive treatment strategies that should reduce diabetic complications (Maureen, et.al, 2013, p. 562). For example, the developments of new classes of medications that lower blood glucose level have helped supplement older therapies such as lifestyle interventions and insulin administrations. These additions have helped increase the treatment options for type 2 diabetes. Type 2 diabetes is progressive with worse glycemic conditions over time. The addition of medications is also not an exception if treatment objectives are to be realized. On the other hand, an early diagnosis is the most important intervention, which is likely to improve the probability of having long-term control over diabetes (Maureen, et.al, 2013, p. 565). These approaches are based on clinical tests that comprised of several modalities of type 2 diabetes. The guideline also follows the goal of maintaining a non-diabetic range in glucose levels given the clinical experience.
Introduction
Type 2 diabetes is prevalent. It has long-term consequences that constitute extreme suffering and huge economic costs. Much of the indisposition associated with the disease’s complications can be toned down using particular interventions that reduce glucose levels to a non-diabetic range. Proficient research and studies have illustrated how several combinations of therapy programs and medications can reduce glucose levels to provide optimal health standings for people with type 2 diabetes. This paper focuses on a summary of the clinical guideline on pharmacological management of type 2 diabetes as well as recommendations stated by the United States Preventive Services Task Force regarding the guideline.
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The Level of Certainty of the Guideline
The United States Preventive Services Task Force released recommendations for the management of type 2 diabetes. These recommendations are meant to be taken on a global perspective even though they lie within the United States. They stress significant points that should be applied in the management of type 2 diabetes worldwide. The USPTSF recommended that there was insufficient evidence to recommend the use of pharmacological interventions (Moyer, 2012, p. 371). This is because the suggested interventions included several approaches to behavioral management activities such as revising nutrition and diet, increasing physical activity, setting weight-loss goals, and maintaining lifestyle changes.
The main factors that have proven to increase the risk of type 2 diabetes are over nutrition and sedentary lifestyles. Both habits are known to result in consequent overweight or obesity. Studies related to the pharmacologic treatment of obesity have featured low sustainability, and high dropout rates (Fradkin, Roberts & Rodgers, 2012, p. 1178). However, given the beneficial effects of lifestyle intervention programs, many experts advocate for such programs to be included in diabetes management. This holistic approach to management of type 2 diabetes has also featured in several guidelines such as the NICE guidelines, the AHA statement, and the NHMRC guidelines. However, these highly advocated guidelines are limited by lack of quality evidence.
The Benefits and Usefulness of the Guideline
According to the USPSTF, good quality evidence includes consistent results from well-steered studies in representative populations that assess effects on health outcomes (Moyer, 2012, p. 375). They also defined fair quality evidence as evidence that is sufficient to determine effects on health outcomes. Nonetheless, the quality and consistency of individual studies limit the strength of the evidence. Since 2003, trials depicted an average weight loss of 4-7 kg. However, according to USPSTF’s guideline committee, they have not yet been able to identify which of the many intervention components is responsible for the weight loss. They have also emphasized on the prevalence of severe liver disease as well as side effects due to the use of orlistat and sibutramine. After the medication trials were discontinued, however, the guideline committee could still not find any evidence related to the maintenance of better weight loss (Moyer, 2012, p. 377). Nonetheless, the USPSTF does provide similar evidence regarding the efficacy of pharmacological interventions on weight loss. The current guidelines emphasize a central theme, which is more behavioral rather than pharmacological. USPSTF recognizes this, and that is why it advocates for gaps in the evidence base to be addressed.
In conclusion, the guideline requires further detail in devising implementation strategies. Also, added specificity is required as regards to who should be responsible for monitoring the implementation of essential interventions.
References
Fradkin, J. E., Roberts, B. T., & Rodgers, G. P. (2012). What's preventing us from preventing type 2 diabetes?. New England Journal of Medicine , 367 (13), 1177-1179.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ...& Matthews, D. R. (2012). Management of hyperglycaemia in type 2 diabetes: a patient-centered approach.Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia , 55 (6), 1577-1596.
Maureen Clement, M. D., Amir Hanna, M. B., Diana Sherifali, R. N., & Jean-François Yale, M. D. (2013). Pharmacologic management of type 2 diabetes.
Moyer, V. A. (2012). Screening for and management of obesity in adults: US Preventive Services Task Force recommendation statement. Annals of internal medicine , 157 (5), 373-378.
Tahrani, A. A., Bailey, C. J., Del Prato, S., & Barnett, A. H. (2011). Management of type 2 diabetes: new and future developments in treatment. The Lancet , 378 (9786), 182-197.
