Treating Type 2 Diabetes: General Principles

• Treatment of diabetes involves re-establishing a normal balance between insulin sensitivity and insulin levels (getting back on the curve).
• Traditional pharmacotherapy has focused on increasing insulin levels with sulfonylurea agents or exogenous insulin (vertical arrow) to re-establish euglycemia with hyperinsulinemia.
• More recently, drugs such as pioglitazone, rosiglitazone, and metformin have been found to improve peripheral or hepatic insulin sensitivity (horizontal arrow), as do medical nutrition therapy and exercise. When effective, these measures reestablish normoglycemia with much less hyperinsulinemia.

Lecture note revised March 2001.