oa SA Pharmaceutical Journal - Effectiveness of diabetes mellitus medicines : an overview : review
The term "diabetes mellitus" refers to a group of disorders that relate to carbohydrate metabolism. The condition is characterised by hyperglycaemia due to decreased and therefore inadequate levels of insulin in the body, resistance to the effects of insulin, or a combination of both. The symptoms of marked hyperglycaemia include polyuria, polydipsia, weight loss, polyphagia and blurring of vision. The aetiological types of diabetes mellitus are type 1, type 2, gestational diabetes mellitus and other specific types. However, the two major categories of diabetes mellitus are type 1 and type 2. Type 1 (formerly known as insulin-dependent diabetes mellitus) patients are usually at risk of developing ketoacidosis and require insulin therapy. Patients who suffer from type 2 diabetes mellitus, formerly known as noninsulin-dependent diabetes mellitus, as opposed to those suffering from type 1 diabetes mellitus, still have functional pancreatic β cells which produce insulin. However, they suffer from a relative lack of insulin, i.e. a combination of insulin resistance and the impaired secretion thereof. These patients may require oral hypoglycaemic agents, or a combination of both oral hypoglycaemic agents and insulin. The effective management of diabetes mellitus is dependent upon three main aspects, namely appropriate dietary modification, suitable exercise and appropriate pharmacotherapy. The more progressive forms of this disease require combination therapy. Uncontrolled diabetes mellitus may lead to the development of micro- and macrovascular complications. Patient compliance is very important in achieving the goal target and positive treatment outcomes. Multiple co-morbid conditions often complicate diabetic treatment and increase the risk of complications. Hypertension and dyslipidaemia are the most common comorbid conditions. Therefore, tight glycaemic and blood pressure control is important in order to prevent disease progression and the development of complications. Important aspects that require consideration when managing individuals with diabetes mellitus are reviewed in this article. The effective management of patients with diabetes mellitus involves a complex decision-making process. The ultimate goal is to attain good glycaemic control. A unique management plan for each patient can be devised through the adoption of a personalised approach to the care of these individuals, which can result in improved outcomes.
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