Treatment of Type 2 Diabetes Mellitus: A Weighty Enigma
Authors: Richard J. Comi
Journal: Annals of Internal Medicine (2005)

Editorials18 October 2005Treatment of Type 2 Diabetes Mellitus: A Weighty EnigmaRichard J. Comi, MDRichard J. Comi, MDFrom Dartmouth Hitchcock Medical Center, Lebanon, NH 03756.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-143-8-200510180-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Successful treatment of the central clinical issues in type 2 diabetes—hyperglycemia and obesity—is difficult, elusive, and often enigmatic. Lifestyle change is difficult, and most pharmacologic treatment options cause weight gain. Faced with an obese patient with failing glucose control, clinicians must decide whether a further reduction in average glucose level by 10 mg/dL to 20 mg/dL is worth another 10 pounds of weight gain. Why do we find ourselves facing this therapeutic dilemma? First, our knowledge of the pathophysiology of type 2 diabetes is largely descriptive rather than mechanistic. We know about insulin resistance and defective insulin secretion, but we ...References1. Heine RJ, Van Gaal LF, Johns D, Mihm MJ, Widel MH, Brodows RG. Exenatide versus insulin glargine in patients with suboptimally controlled type 2 diabetes. A randomized trial. Ann Intern Med. 2005;143:559-69. LinkGoogle Scholar2. Rosenstock J, Zinman B, Murphy LJ, Clement SC, Moore P, Bowering CK, et al. Inhaled insulin improves glycemic control when substituted for or added to oral combination therapy in type 2 diabetes. A randomized, controlled trial. Ann Intern Med. 2005;143:549-58. LinkGoogle Scholar3. Holst JJ, Gromada J. Role of incretin hormones in the regulation of insulin secretion in diabetic and nondiabetic humans. Am J Physiol Endocrinol Metab. 2004;287:E199-206. [PMID: 15271645] CrossrefMedlineGoogle Scholar4. Drucker DJ. Glucagon-like peptides. Diabetes. 1998;47:159-69. 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Clement , Paul Moore , C. Keith Bowering , Rosa Hendler , Shu-Ping Lan , and William T. Cefalu Exenatide versus Insulin Glargine in Patients with Suboptimally Controlled Type 2 Diabetes Robert J. Heine , Luc F. Van Gaal , Don Johns , Michael J. Mihm , Mario H. Widel , Robert G. Brodows , and Efficacy and Safety of Inhaled Insulin Therapy Julio Rosenstock , Bernard Zinman , Liam J. Murphy , Stephen C. Clement , Paul Moore , C. Keith Bowering , Rosa Hendler , Shu-Ping Lan , and William T. Cefalu Metrics Cited byThe safety and tolerability of GLP-1 receptor agonists in the treatment of type 2 diabetes: a reviewLong-term 2-year safety and efficacy of vildagliptin compared with rosiglitazone in drug-naïve patients with type 2 diabetes mellitusWhat to inject when oral agents fail?Inhaled insulins: the present and future of diabetes therapyEfficacy and Safety of Inhaled Insulin TherapyJulio Rosenstock, MD, Bernard Zinman, MD, Liam J. Murphy, MD, Stephen C. Clement, MD, Paul Moore, MD, C. Keith Bowering, MD, Rosa Hendler, MD, Shu-Ping Lan, MPH, and William T. Cefalu, MD 18 October 2005Volume 143, Issue 8Page: 609-610KeywordsDrugsGlucagonGlucoseHemoglobinInsulinInsulin secretionOverweightType 2 diabetesWeight gainWeight loss ePublished: 18 October 2005 Issue Published: 18 October 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...