Published on June 2015 | Medical Science

About Diabetes- A Review

Systematic reviews are the building blocks underlying evidence-based practice; they focusattention on the strengths and limits of evidence from research studies about the effectivenessand safety of a clinical intervention. Type 2 diabetes is an increasingly common disease that is closely associatedwith obesity. In 2005, the prevalence of Indians with diagnosed type 2 diabetes was 2.4percent for adults aged 20-39 years, 10 percent for adults aged 40-59 years, and 21 percent foradults aged 60 years or over. From 1980 through 2004, the number of Indians diagnosed withdiabetes more than doubled, from 5.8 million to 14.7 million. Observational studies and clinicaltrials show that improved glycemic control reduces microvascular complications (e.g., complications involving the eyes, kidneys, or nerves) and may reduce macrovascular complications (e.g., heart attack); however, the effects of specific oral diabetes medications onthese outcomes are less certain. As new classes of medications have become available for the treatment of diabetes, cliniciansand patients have faced a bewildering array of oral medications with different mechanisms ofaction. The first oral diabetes medications were sulfonylureas, which were introduced into themarket in 1955. The second-generation sulfonylureas, which are used today, were introduced in1984. Metformin (a biguanide) was introduced in 1995, meglitinides in 1997, alpha-glucosidase inhibitors in 1998, and thiazolidinediones in 1999. Generally, clinicians must choose between older, less expensive medications such as a secondgeneration sulfonylurea or metformin and the newer, more expensive medications such as a thiazolidinedione or meglitinide. In addition, clinicians must consider concerns about specificmedications conferring excess cardiovascular risks when compared with other oral diabetesmedications or placebo