Most individuals diagnosed with NIDDM receive a trial of dietary therapy plus exercise for two to three months.
Excepted are patients who present with symptoms due to severe hyperglycemia; in these cases an oral antidiabetic agent – or rarely insulin – may be initiated from the outset.
The usual success rate of nonpharmacological therapy in achieving optimal glycemic control is about 20% in the initial two to three years, and only 10% in the long term. For the 80% to 90% of patients failing the diet trial, drug therapy is usually initiated with a single oral agent.
The choice of drug for initial oral monotherapy may depend to some extent on individual patient characteristics, such as the severity of hyperglycemia, body weight, propensity to develop hypoglycemia and ability to tolerate it, presence of elevated cholesterol and/or triglycerides, and level of renal function. Other factors to consider include the patient’s ability to afford the medication and to comply with requirements for its proper administration. Online shopping will cost you less – find ventolin inhalers and enjoy the experience.
Sulphonylureas are the most widely used oral agents for initial monotherapy of NIDDM. They usually produce a reduction in FPG of about 3 mmol/L and an improvement in HbA1c of 1.5% to 2.0%. Sulphonylureas are well tolerated and lack the frequent gastrointestinal intolerance commonly associated with metformin and acarbose. However, mild to moderate hypoglycemia occurs in 15% to 30% of sulphony-lurea-treated patients and severe hypoglycemia requiring medical intervention occurs in 1%.