PHARMACOLOGICAL TREATMENT OPTIONS FOR NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Non-insulin-dependent diabetes mellitus (NIDDM) is a major health conc ern for clinicians who are responsible for the care of an aging popula tion, The relationship between hyperglycemia and the chronic complicat ions of retinopathy, nephropathy, and neuropathy has been established in patients with insulin-dependent diabetes mellitus, and it is extrem ely likely that such a relationship exists in patients with NIDDM as w ell, Diet and exercise are the cornerstone for the management of NIDDM , The assessment of glycemic control should determine which patients w ith NIDDM need more aggressive intervention to control hyperglycemia, Pharmacologic treatment options include oral administration of the sul fonylureas, a biguanide, and an a-glucosidase inhibitor and subcutaneo us administration of insulin, Extensive education about diabetes and s elf-monitoring of blood glucose levels are important components in max imizing glycemic control, Additional pharmacologic treatment options a re necessary when adequate individualized treatment goals are not atta ined, The goal of therapy is to prevent the onset or progression of lo ng-term microvascular and macrovascular complications, In this review, we present the therapeutic options and outline our approach to the ph armacologic treatment of NIDDM, Relevant medical literature on each tr eatment modality is reviewed, and the cost of therapy with use of each medication is provided.