Therapy of Diabetes Mellitus (TDM)


Workshop Outline

This POPS unit deals with some of the acute and chronic manifestations of T1D and T2D, Rational choices for insulin and oral hypoglycemic treatment regimens as well as the influences on their therapeutic action by other medications and conditions will also be presented.

Diabetes mellitus is a disorder of metabolic homeostasis and can be segregated into two general types. Type 1 (T1D), formerly called insulin-dependent diabetes mellitus (IDDM) or juvenile onset diabetes, is usually characterized by the absence of circulating insulin, due to the irreversible destruction of the pancreatic ß-cells by autoimmune mechanisms. Type 2 (T2D), formerly called non-insulin-dependent diabetes mellitus (NIDDM) or maturity onset diabetes, is due to diminished insulin sensitivity in target tissues (insulin resistance) which may present with variable glucose-induced insulin secretion.

Appropriate attention to diet, exercise, and reductions in excess body fat can significantly improve insulin sensitivity in all diabetics. Therapy of T1D requires insulin treatment. In contrast, the mildest forms of T2D may be managed with diet and exercise thus eliminating the need for pharmacologic treatment. However, as severity of the disease progresses, metformin, oral hypoglycemics and other medications may be used if blood glucose levels are not controlled. In the most severe cases, patients with T2D may require insulin administration.

Learning Goals for the TDM Workshop

1. Pathogenesis and etiology of diabetes

a. The student will recognize the mechanisms involved in the under-utilization and overproduction of glucose.
b. The student will be able to describe the processes leading to diabetic ketoacidosis and the concomitant electrolyte abnormalities, particularly the depletion of total body potassium.
c. The student will be able to list the chronic complications associated with the long-term abnormalities in glucose and lipid metabolism. d. The student will be able to identify the microvascular (retinopathy and nephropathy), neuropathic, and macrovascular (atherosclerosis) complications that are associated with progressive diabetes.

2. Therapeutic goals for type 1 diabetes (T1D)

a. The student will be able to formulate an initial insulin treatment regimen and explain the rationale for the choice of different insulin preparations.
b. The student will recognize the impact of pregnancy in the development of T1D.
c. The student will be able to predict the importance of exercise, diet, glucocorticoids and other commonly used medications on fuel metabolism.

3. Therapeutic goals of type 2 diabetes

a. The student will apply evidence-based recommendations to nonpharmacologic and pharmacologic treatment interventions for T2D.
b. The student will be able to list the classes of medications used to treat T2D.
c. The student will describe the mechanisms of action, adverse effects, and prescribing precautions of drugs used to treat T2D.