Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy

The epidemic of type 2 diabetes in the latter part of the 20th and in the early 21st century, and the recognition that achieving specific glycaemic goals can substantially reduce morbidity, have made the effective treatment of hyperglycaemia a top priority [1–3]. While the management of hyperglycaemia, the hallmark metabolic abnormality associated with type 2 diabetes, has historically had centre stage in the treatment of diabetes, therapies directed at other coincident features, such as dyslipidaemia, hypertension, hypercoagulability, obesity and insulin resistance, have also been a major focus of research and therapy. Maintaining glycaemic levels as close to the non-diabetic range as possible has been demonstrated to have a powerful beneficial impact on diabetes-specific complications, including retinopathy, nephropathy and neuropathy in the setting of type 1 diabetes [4, 5]; in type 2 diabetes, more intensive treatment strategies have likewise been demonstrated to reduce complications [6–8]. Intensive glycaemic management resulting in lower HbA1c levels has also been shown to have a beneficial effect on cardiovascular disease (CVD) complications in type 1 diabetes [9, 10]; however, the role of intensive diabetes therapy on CVD in type 2 diabetes remains under active investigation [11, 12]. Some therapies directed at lowering glucose levels have additional benefits with regard to CVD Diabetologia DOI 10.1007/s00125-006-0316-2