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The prevalence of Type 2 diabetes (DM2) has reached epidemic proportions in essentially all industrialized nations. The burgeoning population of DM2 has been attributed to parallel increases in obesity, sedentary lifestyle and less healthy dietary component choices (e.g., high glycemic index foods). By the time DM2 is diagnosed, at least 50% of β-cell function has been lost; this loss appears to progress inexorably, despite treatment. Because control of glucose has been shown to reduce diabetic microvascular complications, and improve quality of life, tools that enhance this process are valuable to clinicians and patients alike. We have evolved in our understanding of DM2 to recognize that multiple metabolic defects contribute to this disorder. Accordingly, it is uncommon that any monotherapy can consistently provide durable control of DM2. Pharmacotherapies that address the multiple metabolic derangements now identified in DM2, especially amongst the incretin class, may also be helpful as they have often...

(1999). Improving Management of Type 2 Diabetes Mellitus: 3. Sulfonylureas. Hospital Practice: Vol. 34, No. 12, pp. 129-140.

The following recommendations summarize the anticoagulation guidelines from the seventh American College of Chest Physicians (ACCP) conference on antithrombotic and thrombolytic therapy and employ an evidence grading scale (summarized in Table 5), at the end of the chapter (1).

Type 2 diabetes mellitus is an increasingly common medical problem for primary care clinicians to address. Treatment of diabetes has evolved from simple replacement of insulin (directly or through insulin secretagogs) through capture of mechanisms such as insulin sensitizers, alpha-glucosidase inhibitors, and incretins. Only very recently has recognition of the critical role of the gastrointestinal system as a major culprit in glucose dysregulation been established. Since glycated hemoglobin A(1c) reductions provide meaningful risk reduction as well as improved quality of life, it is worthwhile to explore evolving paths for more efficient use of the currently available pharmacotherapies. Because diabetes is a progressive disease, even transiently successful treatment will likely require augmentation as the disorder progresses. Pharmacotherapies with complementary mechanisms of action will be necessary to achieve glycemic goals. Hence, clinicians need to be well informed about the various noninsulin alternatives that have been shown to be successful in glycemic goal attainment. This article reviews the benefits of glucose control, the current status of diabetes control, pertinent pathophysiology, available pharmacological classes for combination, limitations of current therapies, and suggestions for appropriate combination therapies, including specific suggestions for thresholds at which different strategies might be most effectively utilized by primary care clinicians.