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Abstract

Type 2 diabetes (T2D) is the most common form of diabetes, a metabolic disorder characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Early diagnosis of T2D and the high-risk category of pre-diabetes may help reduce the associated public health and clinical burden. Available diagnostic strategies include fasting plasma glucose, oral glucose tolerance test, and casual plasma glucose in the presence of symptoms of hyper-glycemia. Potential use of hemoglobin A1c as part of the strategy for screening and diagnosis has been recently proposed. Those with risk factors for T2D should be targeted including patients with overweight/obesity, those with family history of T2D, those aged 45 years and older, race/ethnic minorities (such as Native Americans, African Americans, Latinos, and Asian Americans), women with history of gestational diabetes, and those with metabolic syndrome abnormalities (high blood pressure, low HDL cholesterol, and high triglycerides). Lifestyle modification (i.e., weight loss through diet and increased physical activity) has proven effective in reducing incident T2D in high-risk groups. Prevention trials using pharmacological therapy (metformin, a-glucosidase

From: Contemporary Diabetes: Diabetes and the Brain Edited by: G. J. Biessels, J. A. Luchsinger (eds.), DOI 10.1007/978-1-60327-850-8_2 © Humana Press, a part of Springer Science+Business Media, LLC 2009

inhibitors, or thiazolidinediones) have also reported a significant lowering of the incidence of T2D. As a chronic condition, T2D requires continuous care to prevent damage to various organs, including the eyes, kidney, nervous system, and cardiovascular system. Appropriate glycemic control, blood pressure and lipid management, nutrition and physical activity, taking into account functional status and comorbidities, are needed to prevent microvascular and macrovas-cular complications. A variety of oral antihyperglycemic agents, which target different mechanisms in the pathogenesis of T2D, are as follows: insulin sen-sitizers, insulin secretagogues, a-glucosidase inhibitors, and the new dipeptidyl peptidase (DPP)-IV inhibitors. Injectable agents for the treatment of insulin-deficient T2D include traditional insulin preparations, newer insulin analogs, amylin, and incretin mimetics. Additional aspects of T2D management in the older adult include the assessment of geriatric syndromes and psychosocial screening. Efforts to improve T2D care following recommended guidelines are still very much needed.

Key words: Type 2 Diabetes; Diagnosis; Epidemiology; Prevention; Management; Insulin resistance; Insulin secretion.

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