A Review of Diabetes Treatments and Their Effects on Glycemic Control and Complications of Diabetes

Introduction

Diabetes is associated with the development of microvascular complications (nephropathy, retinopathy, and neuropathy) and macrovascular complications (cardiovascular disease, cerebrovascular disease, and peripheral vascular disease), as well as considerable morbidity and increased mortality. It is now one of the most common diseases in developed countries (with a 2009 UK prevalence of 4%1) and its incidence is rising in developing regions (for instance, the prevalence of diabetes in Africa was 7 million in 2000 and is projected to rise to 18.2 million by 20302). Therefore, effective treatment strategies to reduce the occurrence and progression of these complications need to be employed.

Abstract

INTRODUCTION

The incidence and prevalence of diabetes continues to rise across the world, therefore effective management of this disease is required to reduce the morbidity and mortality associated with this condition via the reduction of hyperglycemia and the macrovascular and microvascular complications of diabetes.

OBJECTIVES

To review the literature and provide an overview of the available treatments for diabetes and their effects on hyperglycemia, glycemic control (measured using glycated hemoglobin [HbA1c]), and diabetes complications.

METHODS

English language articles (including randomized controlled trials, systematic reviews, and meta-analyses) dealing with the relevant subject matter were obtained by searching PubMed.

RESULTS

When used as monotherapy, oral and noninsulin injectable diabetes treatments appear to reduce HbA1c by about 1%, insulin reduces HbA1c by >1%, orlistat reduces HbA1c by about 0.6%, and bariatric surgery reduces HbA1c by >2%. Different treatments have variable effects on pre- and postprandial hyperglycemia. Combinations of treatments produce further HbA1c reductions. Each treatment has its own side effect profile and some have been demonstrated to reduce diabetes complications, as well as reduce the progression from prediabetic states to type 2 diabetes.

CONCLUSION

A variety of options exist for the treatment of diabetes, and the benefits and side effects of each treatment need to be weighed carefully to guide the choice and combination of treatments offered to patients.

Keywords

diabetes, glycemic control, oral hypoglycemic agents, GLP-1 analogues, insulin, orlistat, bariatric surgery