Researchers are trying new approaches to treat Type 2 diabetes amid widespread uncertainty about the most effective therapies and concerns that current strategies might be doing some patients more harm than good.
New guidelines for treating the disease, which many experts consider a public-health crisis among millions of mostly overweight individuals, suggest doctors vary treatments depending on a patient's age, general health and even personal preferences. The recently updated guidelines recommend that doctors back away from pushing patients to get their blood sugar down to a standard targeted level. Aiming for a very low blood-sugar level might be appropriate for a younger person, for example, while older patients might do better with a less aggressive approach, according to the guidelines, published in June in the journal Diabetes Care.
"We need to be less dogmatic about what matters and be open to different approaches and give patients a voice" in treatment decisions, says Victor Montori, a diabetes specialist at Mayo Clinic, in Rochester, Minn., who wasn't involved with writing the guidelines but supports the new direction.
Another approach gaining wider acceptance for some patients is the use of bariatric surgery, which results in dramatic weight loss. Though it comes with risk of serious complications, the operation has been shown in recent studies to lead to a rapid lowering of blood sugar, often enabling patients to go off most or all of their diabetes medicines.
Some experts also are questioning the benefits of gradually stepping up the intensity of drug therapy, a widely accepted approach that was reaffirmed in the latest guidelines. The aim is to maintain a patient's blood-sugar level while keeping up with the progressive nature of the disease. But researchers at UT Southwestern Medical Center in Dallas, for instance, argue in a recent small study that hitting the disease early and hard is better.
More than 24 million Americans have Type 2 diabetes, the version of the disease usually associated with being overweight and living a sedentary lifestyle. By some estimates the number could double by 2025.