Diabetes Mellitus： Too Many Controversies Affecting Care.pdfVIP

June．2013，Volume 10，No．5-6(Serial No．92)，PP．121—127 Journal of US．China Medical Science，ISSN 1 548-6648，USA Diabetes Mellitus：Too Many ControVersieS Care a Ll为 HlN岛 Anil Kumar Manda1 and Linda Marie Hiebert j．Department ofMedicine．University ofFlorida,Gainesville 32611．Florida,USA 2 Department of Veterinary Biomedical Sciences,University ofSaskatchewan．Saskatoon s7N 5B4,Canada Abstract：Diabetes care is in disarray mainly due to a lack of consensus among professionals in the diagnosis and management of diabetes．The most common trend is the use of HbAlc(glycosylated hemoglobin)above 6．5％ in making the diagnosis of diabetes． Similarly．the most common prescription written for treatment of diabetes is metformin，500 mg to l 000 mg twice daily．FBG (Fasting blood glucose)above 126 mg／dL is a common accompaniment of HbAlc，but 2hPPG(2-h postprandial glucose)or 4-h oral glucose tolerance tests are not included in the diagnosis of diabetes．In the early stage of diabetes or impaired glucose tolerance associated with obesity，FBG or HbAIc may be useful，but with rising FBG or HbA1c despite dual or triple oral antidiabetic therapy， 2hPPPG becomes the mainstay to determine the severity of diabetes and the need for initiation of insulin therapy．It is needl ess to underscore that 2hPPG relates to outcome measures such as cardiovascular disorders，nephropathy and death．Thus the cornerstone of therapy when 2hPPG is above 200 mg／dL( l1．1 mmol／L)is insulin with a goal to reduce the risk of complications．There is no or only subtle evidence that oral antidiabetic agents will afect 2hPPG or reduce the risk of complications of diabetes．Therefore，the optimal goal of therapy in diabetes is not limited to merely glycemic control，but the intent of glycemic control which is prevention of diabetes complications． Key words：Diabetes mellitus，2 h postprandial glucose，insulin therapy 1．Introduction Diabetes mellitus or diabetes is the biggest chalenge in current medical practice． Challenge