Radhika Bhaskar, Rahul Bhaskar, Mahendra K. Sagar and Vipin Saini
Diabetes, an epidemic, has become a point of concern as far as healthcare crisis are concerned in developing and developed countries. The therapy against type 2 diabetes is aimed to get control over metabolism of glucose with due consideration on safety point also. The target of therapy is to maintain the HbA1c value < 6.5% at the early stages of the disease and < 7.5% at advanced stages or when patient is at a risk of hypoglycemia. The treatment is categorized in three steps. The first step starts at early stages of the disease, when hyperglycemia is not too high and value of HbA1c lies between 6.5%-8.5%. Though several oral hypoglycemic agents (OHA) are available, metformin is considered as drug of choice. Other alternatives are recommended only if patient is not able to tolerate metformin or it is contraindicated with other components. However if metformin fails to control the situation and level of hyperglycemia reaches as high as HbA1c > 8.5%, one should move to second step which includes addition of a second drug with a synergistic action. Out of various available options of OHA, the dose and combination individualization are supposed to be carried out. The condition, if not under control, even after step 2, this is a call for the third step, which incorporates either oral triple therapy or introduction of basal insulin (condition apply that patient is not insulin- resistant).
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