Discuss the short-term and long-term management of this disorder.

Short-Term Management of Type 2 Diabetes Mellitus

Short-term management focuses on achieving glycemic control during acute illness, managing hyperglycemic crises, and initiating treatment in newly diagnosed patients.

• Diagnosis: Initial diagnosis typically involves fasting plasma glucose (FPG) ≥126 mg/dL, HbA1c ≥6.5%, or a 2-hour plasma glucose ≥200 mg/dL during an oral glucose tolerance test (OGTT).
• Lifestyle Modifications: Immediate implementation of dietary changes (reduced carbohydrate intake, increased fiber), regular physical activity (at least 150 minutes of moderate-intensity exercise per week), and weight management are essential.
• Pharmacological Intervention:
  • Metformin: Often the first-line drug, improving insulin sensitivity and reducing hepatic glucose production.
  • Sulfonylureas: Stimulate insulin secretion, but carry a risk of hypoglycemia.
  • DPP-4 Inhibitors & GLP-1 Receptor Agonists: Enhance incretin effects, promoting insulin release and suppressing glucagon secretion.
  • SGLT2 Inhibitors: Increase glucose excretion in urine.
• Monitoring: Frequent self-monitoring of blood glucose (SMBG) is crucial, especially when initiating new medications or adjusting dosages.
• Management of Hyperglycemic Crises: Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS) require immediate hospitalization and intravenous fluids, insulin therapy, and electrolyte correction.

Long-Term Management of Type 2 Diabetes Mellitus

Long-term management aims to prevent complications, maintain glycemic control, and improve quality of life.

• Glycemic Control: Target HbA1c levels are generally <7%, but individualized based on patient age, comorbidities, and risk of hypoglycemia.
• Pharmacological Management (Continued):
  • Insulin Therapy: May be required as the disease progresses, particularly if oral agents are insufficient. Various insulin regimens (basal, bolus, premixed) are available.
  • Combination Therapy: Often necessary to achieve optimal glycemic control, utilizing multiple drug classes with complementary mechanisms of action.
• Cardiovascular Risk Management:
  • Blood Pressure Control: Target <130/80 mmHg. ACE inhibitors or ARBs are often preferred, especially in patients with nephropathy.
  • Lipid Management: Statins are recommended to lower LDL cholesterol levels.
  • Antiplatelet Therapy: Aspirin may be considered for primary prevention in high-risk individuals.
• Screening for Complications:
  • Annual Diabetic Retinopathy Screening: Fundoscopic examination.
  • Annual Diabetic Nephropathy Screening: Urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR).
  • Annual Diabetic Neuropathy Screening: Foot examination and monofilament testing.
• Patient Education & Self-Management: Empowering patients with knowledge about their condition, medication adherence, healthy lifestyle choices, and complication recognition is vital.

Comparison of Oral Antidiabetic Drugs

Drug Class	Mechanism of Action	Advantages	Disadvantages
Metformin	Decreases hepatic glucose production, improves insulin sensitivity	Effective, inexpensive, weight neutral	Gastrointestinal side effects, lactic acidosis risk
Sulfonylureas	Stimulates insulin secretion	Effective, inexpensive	Hypoglycemia risk, weight gain
DPP-4 Inhibitors	Enhances incretin effects	Well-tolerated, low hypoglycemia risk	Modest glycemic control
SGLT2 Inhibitors	Increases glucose excretion in urine	Cardiovascular and renal benefits	Genital mycotic infections, dehydration