Individualizing Treatment of type 2 Diabetes

Abstract

Type 2 diabetes (T2DM) is a heterogeneous disorder. It affects the young, middle aged and elderly. Some patients with T2DM are obese and some are lean. A category of individuals in these groups posses a cluster of cardiovascular risk factors named as metabolic syndrome comprising dyslipidemia, high blood pressure and central obesity. All these features highlight the heterogeneity and different phenotypes of T2DM. Hyperglycemia is the main therapeutic target in the management of T2DM. Over many decades, a number of oral hypoglycemic agents (OHA) have been introduced to control hyperglycemia in this disorder. Professional organizations formulated guidelines to use OHAs in T2DM. Most of these guidelines stipulate a vertical approach in selecting and adding OHAs. With the availability of more OHAs and better understanding of the heterogeneity of diabetes, there is a paradigm shift in the guidelines in the management of hyperglycemia in diabetes. The most recently advocated approach endorses an individualized treatment based on the age, impact of weight gain or necessity of weight loss, target glycemic control, risk of hypoglycemia, cost and patient safety in selecting the most appropriate OHA for a given patient with T2DM. This article aims to address some clinically relevant issues related to the individualized therapy in T2DM.