DIABETES MELLITUS-GENERAL MANAGEMENT
SUMMARY
To induce diabetes remission:
1. Intensive lifestyle/calorie restriction: 73% of those who lost 10kg or more had remission in 1 year. B cell function did not improve in non-responders[1].
2. Intensive insulin or other medical therapy: the RISE study showed Improved B cell function at 12 months on active therapies in adults but returned to pre-Rx after treatment withdrawal but no beneficial effect on B cell function in youths[2].
3. Bariatric Surgery: Roux-en-Y gastric bypass (most effective), biliopancreatic diversion, sleeve gastrectomy, adjustable gastric banding (least effective) for both adult and youth-onset diabetes. Surgery is also useful in primary prevention of DM.
4. Manage hyperlipidemia, HTN, avoid smoking, preserve renal function, lifestyle modification, antiplatelet therapy, strict glycemic control.
Reference(s)
- ↑ Thom, G., Messow, C.-M., Leslie, W.S., Barnes, A.C., Brosnahan, N., McCombie, L., Al-Mrabeh, A., Zhyzhneuskaya, S., Welsh, P., Sattar, N., Taylor, R. and Lean, M.E.J. (2021), Predictors of type 2 diabetes remission in the Diabetes Remission Clinical Trial (DiRECT). Diabet Med, 38: e14395. https://doi.org/10.1111/dme.14395
- ↑ RISE Consortium. Restoring Insulin Secretion (RISE): design of studies of β-cell preservation in prediabetes and early type 2 diabetes across the life span. Diabetes Care. 2014;37(3):780-8. doi: 10.2337/dc13-1879. Epub 2013 Nov 5. PMID: 24194506; PMCID: PMC3931376
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
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Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
