By Martha Funnell, MS, RN, CDE

When people with diabetes get together, one of the things they often ask one another is: “How do you treat your diabetes?” There are often as many ways to treat diabetes as there are people in the room. It is no surprise that many people with diabetes wonder about the best treatment for diabetes and whether their diabetes is being treated the right way.

We’ve always believed that the best treatment for diabetes is the one that keeps your blood glucose level on target, has the fewest side effects and costs the least. Experts from the United States and Europe got together recently to discuss treatment options for type 2 diabetes. Two very important points came from those discussions.

Using Medicines

One thing the experts agreed on is that medicines should be used right from the start. In the past, medicines were often not given until after a year or more of diet and exercise. Although meal planning and exercise are still part of most treatment programs, experts now recommend starting a diabetes medication at the time of diagnosis. Metformin (Glucophage) is often the first choice. If that causes too many side effects, a sulfonylurea (Micronase, Glucotrol) can be used instead. Over time, other medicines may be needed. The next step is to add another pill, such as a glinide (Prandin, Starlix) or a TZD (Actos). The second recommendation the experts came up with is that insulin should be used earlier in the treatment of type 2 diabetes. Insulin or another type of hormone that is given as a shot— exenatide (Byetta)—is used.

3 Points from the recommendations

1. There is clear evidence that keeping blood glucose levels as close to normal as possible is the best way to lower your risk of complications, such as heart attacks and strokes.
2. There is a growing understanding of type 2 diabetes as a progressive disease. This means that the way your diabetes is treated must change as your body changes. Over time, the pancreas puts out less insulin. For some people, meal planning and exercising will not be enough to bring their blood glucose into the target range. Taking diabetes medicine does not mean that you have failed. Medicines are no longer thought of as a last resort. They are simply a step in your treatment.
3. A1C levels and complication rates have not changed much in recent years, even though we now have new therapies. Experts hope that starting medicines, such as insulin, sooner will help people live longer, healthier lives.