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<h1>Type 2 Diabetes (T2DM): Challenges to Treatment</h1> <p>Nearly 21 million of our citizens are affected with this disease. Probably another 40 million have prediabetes. You see the costs, $132 billion were spent in 2002. And frankly, I don't think anyone thinks that statistic is still current. It's probably more now. Complications that are associated with this disease; all the different organ abnormalities: blindness, limb amputation,<p> <h2> Risk Reduction for Diabetes Patients</h2> <p> One of the most important things that's happened in our world in the last ten to 15 years regarding diabetes is a clear understanding that we can make an impact as practitioners, and truly improve the hopes and outcomes for our patients.</p> <p>Aggressive, blood glucose control has an impact on what happens to those patients, clearly, from a microvascular point of view, meaning the eyes and the kidneys and the leg problems. And maybe even protecting against cardiovascular disease. . The UKPDS (United Kingdom Prospective Diabetes Study, which was published in 1998)shows that agressive glucose control has impact on microvascular complications. In the diet group, the average hemoglobin A1c over maybe ten years was 7.9, and in the treated group, the average was 7.0. And in many ways, that one percent reduction in hemoglobin A1c, I think we would have predicted, initially, probably wouldn't have much of an impact. But what this slide shows you is clearly the opposite, that one percent reduction was associated with very large reductions in microvascular complications. </p> <p>improving blood glucose values in our patients with type two diabetes has an impact on their long term health, and it's really our obligation to try and help them get that help.</p> <h2> Recommended targets for type 2 diabetes patients</h2> <p>Treat the whole patient. The reality is, if most patients in this country had a hemoglobin A1c of less than seven percent, we would have a big impact on what happens to them. The clear messages that goes out to our practicing community is, work hard on attaining all of these standards, A1c less than seven, blood pressure less than 130, LDL less than 100, triglycerides less than 150. Because they all have an impact on what happens to our patients. Need strategies to attain all these goals.</p> <h2>Are Patients meeting ADA Clinical practice Recommendations?</h2> <p>In this country, we estimate maybe 50 percent of the patients with diabetes have their A1c to goal. But just as important, 50 percent don't. And in fact, when you start to look at those patients, most have a hemoglobin A1c above eight percent. So clearly, we still have lots of room to work in terms of blood glucose control.<p> <h2>Blood Glucose Control and Overcoming Patient Barriers to Insulin Treatment</h2> <p> Patient barriers summarized: feeling of failing, needle phobia, fear of further complications, insulin is clearly linked to a negative perception.</p> <p>Diabetes is progressive, need for insulin is not a sign of failure. This is how the disease works. Needle phobia. Show the patients that the needles are painless. Inject them with a saline solution in the office. Regarding complications: insulin doesn't cause further complications, it is used to prevent complications associated with advanced diabetes.</p> <h2> Clincians Concerns about Insulin Therapy in type 2 diabetes (T2DM)</h2> <p>Hypoglycemia, artherosclerosis, weight gain and negative perceptions of patients. Risk of severe hypoglycemia is unusual in patients on insulin who have type two diabetes. The issue of worsening atherosclerosis really is historical. It's not factually correct. There is some weight gain potentially with insulin. Not always: get the patient focused on life-style and exercise. also, if you use metformin with insulin there is a substantial lessening of the risk of weight gain. Regarding patients negative perceptions about insulin therapy. Emphasize the positive. "We are going to fix your blood sugars and lower your risks."</p> <h2> Diabetes Education: Diabetes Self Management Training</h2> <p>Utilize CDEs in your community to help your patients. Let your patients see CDEs.</p> <h2>Summary of type 2 diabetes treatment challenges</p> <p>Diabetes is an epidemic today. Diabetes is associated with risk of developing long-term morbidities. We are not meeting the clinical goals for glycemic control. Specific challenges exist for the clinician and the patient when initiating care and treatment of diabetes. Patient education can be a key in achieving treatment goals.</p> <p>Follow national standards of care. Lower risk of microvascular and macrovascular complications. Be agresssive about using insulin in patients. Help patients to overcome their fears. Become comfortable with starting insulin, because you will be a good healthcare provider if you do that, and many of your patients need it.</p>