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Jeffrey S. Freeman, DO, FACOI, Division of Endocrinology and Metabolism, Philadelphia College of Osteopathic Medicine, PA.

E-mail address: JeffreyFreemanDO@aol.com.

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Diabetes management for outpatient accounts for millions of office encounters annually. Successful care for the patient with type 2 diabetes mellitus (T2DM) requires not only a focus on glucose management, but also comorbidities, including hypertension, dyslipidemia, and obesity.

Given the epidemic of T2DM, osteopathic physicians are seeing more patients with this condition and incurring more complex challenges. Primary care physicians are the front line in patient care. They are positioned to serve a pivotal role in managing obesity and diabetes. While coordinating appropriate medical treatment, osteopathic family physi- cians act as teachers and educated patients take a more proactive approach in their care.

Effective metabolic control has been shown to reduce the morbidity and mortality associated with T2DM.1-4 How- ever, a large proportion of patients are not achieving glycemic goals—less than 40% of patients are achieving the American Diabetes Association A1C goal of o 7%,5 and only about 1 in 3 are achieving the American Association of Clinical Endocrinologists A1C goal of r 6.5%.6

The key issues in the management of T2DM include early detection of problems, realistic goal setting, improved patient adherence, better knowledge and understanding of pharmacotherapeutic treatment options, and prompt inter- vention.16 Successful treatment requires attention to the cardiometabolic effects of medications used to lower blood glucose and a comprehensive approach to the patient.15

Treatment for patients with T2DM should include lifestyle modification and should address other comorbidities for which the patient may be at risk.17 Physicians must also be knowledgeable about the recommendations for glycemic goals and apply the treatment algorithms put forth by the American Diabetes Association/European Association for the Study of Diabetes18 and the American Association of Clinical Endocrinologists/American College of Endocrinol- ogy in the management of patients afflicted with T2DM.14 Patients with T2DM have generally been treated similarly despite the fact that they may have underlying differences that could affect their therapeutic response.7 For decades, the standard treatment paradigm has been “treat to fail” rather than “treat to succeed.” Typically, therapeutic strategies started with diet and exercise, with the slow and sequential addition of drugs.8 Many patients and physicians have been frustrated with the limitations of currently available agents with regard to weight gain, hypoglycemia, and tolerability issues. Recent initiatives are calling for patient-specific and patient-oriented treatment approaches.7,9 Primary care phy- sicians must remain updated on the latest published diabetes literature and new treatment modalities to provide the greatest quality care for these increasingly complex patients.10 Treatment recommendations for managing the hyperglycemia of T2DM continue to evolve.11-15

I am hopeful you find the read as enjoyable as it was to collaborate with experts in the preparation of this manuscript.


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