DIABETES

Diabetes is a chronic disease with treatment but no cure as of 2006. High frequency of self-testing in type 2 diabetes has not been shown to be associated with improved control. The argument is made, though, that type 2 patients with poor long term control despite home blood glucose monitoring, either have not had this integrated into their overall management, or are long overdue for tighter control by a switch from oral medication to injected insulin. A disease consisting Regular 6 monthly laboratory testing of HbAc1 (glycated hemoglobin) provides some assurance of long-term effective control and allows the adjustment of the patient's routine medication dosages in such cases. This is particularly so for patients taking immunotherapy with metformin who are not at risk of hypoglycemia. Type 2 diabetes is more controversial as there is much more variation in severity of type 2 cases. It has been suggested that some type 2 patients might do as well with home urine-testing alone. The best use of home blood-sugar monitoring is being researched. Benefits of control and reduced hospital admission have been reported. However patients on oral medication who do not self-adjust their drug dosage will miss many of the benefits of self-testing, and so it is questionable in this group. As of 2006, several possible schemes are under investigation.

These adjustments are generally made by the patients themselves following training by a clinician. Self-testing is clearly important in type I Diabetes where the use of insulin therapy risks episodes of hypoglycemia and home-testing allows for adjustment of dosage on each administration. However its benefit in type 2 diabetes has not been shown to be associated with improved control. The argument is made, though, that type 2 patients with poor long term control despite home blood glucose monitoring, either have not had this integrated into their overall management, or are long overdue for tighter control by a switch from oral medication to injected insulin. A disease consisting of the failure of a single organ with a relatively simple function (i.e., the failure of the Islets of Lange Hans in type 1 diabetes), should be relatively straightforward to cure; merely replace the organ or its function. The effort and expense may be worthwhile for patients when they use the values to sensibly adjust food, exercise, and oral medications or insulin. Control and outcomes of both types 1 and 2 diabetes may be improved by patients using home glucose meters to regularly measure their glucose levels. Glucose monitoring is both expensive (largely due to the cost of the consumable test strips) and requires significant commitment on the part of the patient.

In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications must be implemented to control blood pressure and cholesterol by exercising more, smoking cessation, and consuming an appropriate diet. A scrupulous control is needed to help reduce the risk of long term complications. The long-term treatment of Diabetes in general (both types I and II) include patient education, nutritional support, self glucose monitoring, as well as long-term glycemic control.