Optimal strategies for the manegement of T2DM

– minimal cost strategy

– minimal weight gain strategy
– minimal patient effort strategy
– hypoglycemia avoidance strategy
– postprandial control strategy
– Tight glycemic control strategy
 Minimal cost strategy
• Lifestyle Modification
• Metformin
• Sulfonylurea
• Insulin
 Minimal cost strategy
• This must be seen in the context of how much
is needed to treat more than 200,000 diabetic
patients in Kuwait ( about 20% of the
population ) >>> 50% of them cannot effort
new expensive medication e.g DPP-4 , Glinids.
 Minimal Weight gain
• Metformin
• Acarbose
• GLP-1 agonist
• DPP-4 inhibitor
• Minimizing risk of hypoglycemia is a priority. It
is a matter of safety, adherence, and cost.
Hypoglycemia avoidance strategy
ED ADMISSION FOR HYPOGLYCEMIA DIABETID
PATIENTS
Drug induced hypoglycemia
 Hypoglycemia avoidance strategy
• MFN
• AGI
• TZD
• GLP-1 agonist
• DPP-4 inhibitor
• SGLT-2 inhibitor
 Post prandial control strategy
• Glinides
• AGI
• Short acting insulin
 Tight glycemic control strategy
• Insulin
• Metformin
• Sulfonylurea
 The Miracle of Insulin

Patient J.L., December 15, February 15, 1923

1922
The Most Powerful Agent We Have
to Control Glucose