Treating Type 2 diabetic patients, especially those who are obese, is a challenging task for any doctor.
According to Dr. Vikas Ahluwalia, President of the Diabetes Care Foundation of India, apart from blood sugar levels, there are several other treatment end points and issues that need to be addressed in such patients.
He says that the basic pathophysiology of type 2 diabetes includes three main defects, namely insulin deficiency, excess glucose output and insulin resistance.
Despite the advances in the management of diabetes and development of newer better insulins, there are various unsolved problems in the treatment of obese type 2 diabetic patients as in:
1. HbA1c targets are achieved only in a minority of patients.
2. Increase in body weight by most anti-diabetic drugs (insulin, sulfonylureas, glitazones)
3. Weight gain is associated with an increase in blood pressure, LDL, and chronic inflammation as well as decrease in HDL.
4. Risk of severe hypoglycemia is high in type 2 diabetic with long standing disease.
5. Continuous progression of diabetes deterioration caused by beta cell loss.
