Patient-centred treatments for type 2 diabetes.

摘要

Type 2 diabetes mellitus is a common, chronic, heterogeneous disorder that is difficult to control adequately with pharmacotherapy and is associated with other vascular risk factors, target organ complications, and increased mortality. Today's Lancet includes a report of APOLLO, a randomised trial that tested insulin-based approaches to improve glycaemic control in patients with type 2 diabetes. Many drugs, including several forms of insulin, are available to treat type 2 diabetes.5 Experts have recently provided an algorithm to choose among these options5 largely on the basis of action and cost. Many experts have debated the relative importance of fasting glucose and postprandial glucose as targets of therapy, assessing their association with surrogate measures of control, such as concentration of haemoglobin A_(1c) (HbA_(1c)) and organ damage. APOLLO was done to address this issue. A similar study is the Treating to Target in Type 2 Diabetes (4-T) trial that includes an additional group of patients given premixed insulin twice daily. These studies differ in location, study design, and therapeutic targets.