Diabetes Mellitus is a disease of the endocrine system primarily differentiated between type 1 and type 2. Type 1 diabetes occurs when the pancreas is unable to produce insulin and was previously seen in the younger generation which is no longer the case.1 Type 2 diabetes is the more prevalent of the two types and involves elevated blood sugar levels due to the insufficient production of insulin. Risk factors that make an individual higher risk for type 2 diabetes include increasing age, obesity, family history, a sedentary lifestyle.1,2 Innovative drug therapies for type 2 diabetes remain important for the treatment and reduction of the disease.
The prevalence of diabetes according to the CDC is 26 million Americans currently diagnosed with diabetes, 79 million with pre-diabetes, and 7 million unaware they have diabetes.1 Diabetes is currently more prevalent in the western countries due to physical inactivity and obesity, but as more Eastern countries develop the western lifestyle it becomes an increasing worldwide epidemic.1 The risk for developing type 2 diabetes increases with age (especially after age 40), but is increasing most rapidly in the adolescent and young generation.1 It is therefore critical that education as well as drug therapies are implemented to decrease the rising prevalence of this illness.
The pathophysiology of type 2 diabetes is characterized by both insulin resistance and insulin secretion. Peripheral insulin resistance and inadequate insulin secretion by the pancreas due is due to beta cell dysfunction. The resistance results in elevated free fatty acids and inflammation which leads to an overall decreased amount of glucose taken up into the muscle, increased glucose production, and increased broken down fat.1,2 Post-prandial levels will increase first, and eventually the high glucose levels lead to suppression of gluconeogenesis. 1
The accurate diagnosis of type 2 diabetes is important in determining the appropriate treatment regimen. Tests utilized for the diagnosis include the A1C , fasting plasma glucose, and the oral glucose tolerance test. The A1C analyzes blood levels from the previous 3 months to see the levels without daily fluctuations. The fasting plasma glucose test is the most common test utilized where the patient fasts for 8 hours and the glucose levels are analyzed in the morning. The oral glucose tolerance test is more beneficial for patients with gestational diabetes, but it is less convenient because the patient has to fast for 8 hours and then 2 hours after the ingestion of 75 g of glucose the levels are read.2 A diagnosis of diabetes must be confirmed with either 2 different tests or the same test performed twice.2 After the diagnosis the appropriate treatment regimen must be implemented. Initial therapy for patients diagnosed includes management through diet and exercise along with smoking cessation, and lowering of blood pressure and cholesterol. First line...