Glycemic control, mealtime glucose excursions, and diabetic complications in type 2 diabetes mellitus

Type 2 diabetes mellitus is a heterogeneous disorder characterized by 2 pat hogenic defects, impaired insulin secretion and insulin resistance. The res ultant hyperglycemia causes microvascular and macrovascular complications t hat increase morbidity and mortality in patients with diabetes mellitus, Op timum glycemic control in patients with type 1 and type 2 diabetes mellitus prevents the development of microvascular disease and, to a lesser extent, macrovascular disease. Prandial hyperglycemia may be an independent risk f actor for the development of diabetic complications. This article reviews t he pathophysiologic mechanisms of glucose metabolism and describes the resu lts of epidemiological and interventional studies that have demonstrated th e association of acute and chronic hyperglycemia with the development of di abetic complications. The American Diabetes Association has defined diagnos tic and treatment goals for diabetes mellitus, striving to achieve near-nor mal glycemic control to delay or prevent the development of diabetic compli cations, A number of oral antidiabetic agents and insulins are currently av ailable for the treatment of type 2 diabetes mellitus in the United States. These agents target fasting and postmeal plasma glucose levels to improve glycemic control, Alone or in combination, these agents have enhanced the c linical approaches to treating diabetes mellitus.