Modern Treatments for Type 2 Diabetes

By Naveed Saleh, MD, MS. Medically reviewed by Tom Iarocci, MD. May 7th 2016

There is still no cure for diabetes, but treatments are more effective than ever before. Management of this disease involves lifestyle modification, such as diet and exercise; possible insulin; oral medication or bariatric surgery. Put simply, treatment for most people with diabetes is a lifelong, multilayered pursuit.

“At the present time, there is no cure for either type 1 or type 2 diabetes,” says physician Robert Ratner, M.D., chief scientific and medical officer at the American Diabetes Association. “We’ve learned how to manage this chronic disease, and we’ve become fairly effective in reducing the risk of complications.”

Most type 2 cases are caused by a relative deficiency of insulin due to the body’s reduced sensitivity to the hormone. In other words, the hormone insulin (produced by the pancreas) helps absorb and regulate excess sugars (or glucose) from the blood. Interestingly, both your environment and your genetics play key roles in the development of type 2.  

Updating medical approaches to diabetes

Type 2 diabetes is an insidious disease, which, left untreated, can cause heart problems, kidney disorders, eye problems and eventually, death, according to the Centers for Disease Control and Prevention. To combat the epidemic, in recent years, diabetes intervention has become multidisciplinary, involving primary care physicians, nutritionists, ophthalmologists, cardiologists, podiatrists and other specialists, says Ratner.

“The American Diabetes Association has also gotten away from ‘first use this [medication], then use that,’ then use something else,” Ratner says. “Now it is a more patient-centered approach because we understand that different patients respond differently to medications at different stages in their disease.”

Today, health care providers are also better at explaining the nutritional management of sugars to patients and stressing the importance of daily monitoring of blood sugar.

Types of type 2 diabetes treatments

Modern treatments of type 2 diabetes largely consist of eliminating symptoms associated with hyperglycemia by curtailing damage to blood vessels and enabling a person with diabetes to live without disability.

There are three types of diabetes treatments, and a person with diabetes may eventually progress through all stages. As a last resort for obese patients with type 2 diabetes, surgery has also been proven highly successful in the treatment of diabetes.

  • Stage one: Non-drug therapy. Diet and exercise remain the cornerstones of diabetic treatment. A dearth of research proves that even a moderate reduction in weight can slow the progression of diabetes. For example, a 200-pound man need only lose 15 or 20 pounds before enjoying drastically improved blood sugars.

Diets for people with diabetes are also tailored to their specific medical history. For example, an obese person should maintain a diet lower in fats; a person susceptible to large fluctuations in blood sugar should avoid simple carbohydrates and increase fiber intake; a person with heart disease should lower intake of saturated fats; and, finally, a person with kidney problems should consume less protein, which taxes kidney function.  

  • Stage two: Oral medications. Oral medication may eventually become a necessity for people with type 2 diabetes. The medication mainstay is metformin, effective only in the presence of insulin; it helps insulin do its job by decreasing glucose output from the liver. Encouragingly, new oral medications are being developed; canagliflozin is one new drug recently approved for some people with diabetes.
  • Stage three: Insulin. Insulin is usually injected under the skin, and there are more than 20 types of insulin available in the U.S. Physicians take many factors into consideration when prescribing insulin regimens since they differ in cost, composition and duration of action (or how long they work).
  • Surgery: When all else fails, medical experts may recommend bariatric or weight-loss surgery; it’s a highly effective treatment for obese patients with type 2 diabetes.

“If you get bariatric surgery and you don’t have diabetes, then you significantly reduce possible development of diabetes,” says Ratner. “If you have bariatric surgery on top of known diabetes, you will likely experience a rapid reduction in the need for medication following surgery.”

However bariatric or weight-loss surgery may not be able to completely eliminate the need for medication. Up to 50 percent of overweight or obese patients who have diabetes 2 and bariatric surgery will have to go back on medication at some point, he adds.

“It’s not uncommon to see individuals with progressive type 2 diabetes move from lifestyle interventions to one pill, then gradually progress to a combination of two pills, to a combination of pills plus insulin,” Ratner says. “If you live long enough with type 2 diabetes, most people will require insulin.”

Take the next steps

Depending on where you are in the spectrum of diabetes, talk to your health care provider regularly about lifestyle modifications. Ratner suggests seeing a registered dietician who can streamline your diet before you’re forced to take medication.

“To assess exercise tolerance, all patients should consult their physicians before beginning any exercise regimen,” he cautions. However, Ratner also says that 30 minutes of vigorous walking five days a week can safely improve everybody’s ability to regulate blood sugars.

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