Strategies of the treatment of type II diabetes mellitus.

In Type Diabetes mellitus (DM), the two primary defects that occur are insulin resistance and impaired insulin secretion. Currently, no data exist showing improved outcomes or reduced macrovascular complications with tight glycemic control in Type II DM, and only minimal data shows a reduction of microvascular complications. Still, the current standard of practice is to attempt to attain glycemic goals in patients with Type II DM. As an attempt to resolve this issue, the United Kingdom Prospective Diabetes Study (UKPDS) was initiated. This 11-year study is comparing conventional therapy to intensive therapy in patients with Type II DM. The American Diabetes Association's (ADA) guidelines state that either sulfonylureas, metformin, acarbose, or insulin can be used as first-line treatment for Type II DM; however, oral agents can be attempted first in most patients. Until results from the ongoing UKPDS trials are available, the guidelines for glycemic control from the ADA should be followed.