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Update in diabetes management.

Article Excerpt
Over 23 million children and adults in the United States, or about 7.8% of the population, have diabetes (American Diabetes Association [ADA], 2008b). Another 6 million persons may have the disease and not be aware of it.

Type 1 diabetes results from beta cell destruction, leading to the body's inability to produce insulin (Funnell, 2007). This disease affects about 5%-10% of those Americans diagnosed with diabetes (ADA, 2008a). Type 2 diabetes, previously known as adult onset diabetes, is caused by insulin resistance (the body fails to use insulin correctly) combined with an insulin deficit. This is the most common form of diabetes in Americans. Gestational diabetes (diabetes of pregnancy) is characterized by glucose intolerance and affects about 7% of all pregnancies (Funnell, 2007). About 5%-10% of women with gestational diabetes will be diagnosed with type 2 diabetes after pregnancy (ADA, 2008a).

With this rise in the number of patients with a diagnosis of diabetes, particularly type 2 diabetes, nurses should be aware of the changes in disease treatment. In this column, four new injectable drugs will be reviewed: two basal insulins, insulin detemir (Levemir[R]) and glargine (Lantus[R]), rapid acting insulin; insulin glulisine (Apidra[R]), and an injectable incretin mimetic exenatide (Byetta[R]). The withdrawal from market of the only human insulin inhalation (Exubera[R]) also will be discussed.

Insulin Therapy

Insulin therapy is required for the treatment of type 1 diabetes due to the absolute insulin deficiency. However, the patient with type 2 diabetes may have various abilities to produce insulin. Treatment of type 2 diabetes involves lifestyle changes, can include oral antidiabetic agents, and may eventually require insulin therapy (ADA, 2008b).

In type 2 diabetes, early treatment with insulin therapy can help preserve beta cell function. However, both clinician and patient resistance to starting or adding insulin therapy can come from the fear of self-injection, weight gain, and risk of hypoglycemia that can result from treatment with insulin (Funnell, 2007). The ADA (2008a) identified the treatment goal for these patients as glycemic control with prevention of hypoglycemia. The new basal insulins now can take a role in glycemic control...

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