DIABETES MELLITUS-GENERAL MANAGEMENT

From NeuroRehab.wiki

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)

  1. 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
  2. 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


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Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].