**5. Use of statin and antiplatelet therapy**

The use of statin is the other core element to prevent the premature death and disability in diabetes. The mechanisms of beneficial effects of statins in CVD are not completely understood. Some beneficial effects appear to occur independently of lowering of LDL cholesterol. Thus, most trials of statins and CVD outcomes tested specific doses of statins against placebo or other statins rather than aiming for specific LDL cholesterol goals, suggesting that the initiation and intensification of statin therapy should be based on risk profile [25, 32]. Before starting statin, lipid profile should be required at least once; a fasting sample is not routinely needed [32]. Antiplatelet therapy in diabetes is generally recommended for those with history of CVD and dual antiplatelet therapy is reasonable for up to 1 year after an acute coronary syndrome [25, 32].

**7. Antihyperglycemic medications**

**7.2. Risk of hypoglycemia**

is given below [21]:

**Figure 3**. A few pertinent points are further discussed below.

**Research perspectives:** Compared with the BMI cut point of 30.0 kg/m<sup>2</sup>

bution is observed at corresponding BMI cut points of 21.0 kg/m<sup>2</sup>

**7.1. Reduction of insulin resistance and beta-cell workload**

Type 2 diabetes is a chronic metabolic condition characterized by insulin resistance and insufficient pancreatic insulin production from beta-cell, resulting in high blood glucose levels [39]. Difficulty in utilizing the available insulin increases the workload of beta-cell. While using antihyperglycemic medications, the issues that need to be considered are shown in

Aboriginals in Canada [38]. The BMI cut points are, however, higher, for the lipid and blood pressure factors than for the glucose factor in South Asians, Chinese, and Aboriginals in the study [38] pointing out the need to study BMI cut points

in different populations similarly considering the glucose, lipid and blood pressure factors separately.

among Europeans, a similar glucose factor distri-

http://dx.doi.org/10.5772/intechopen.71193

in Chinese and 21.8 kg/m2

in

183

in South Asians, 20.6 kg/m2

Principle of Management of Type 2 Diabetes: From Clinical, Public Health…

Beta-cell failure is central to the ultimate development and progression of type 2 diabetes and it antedates and predicts diabetes onset and progression [40]. Subjects with normal glucose tolerance with 2-hour plasma glucose 120–139 mg/dL may have already lost 50% of beta-cell function, whereas subjects with impaired glucose tolerance with 2-hour plasma glucose 180– 199 mg/dL have lost up to 80% of beta-cell function. Thus, when the diagnosis of diabetes is made, the patient may have already lost 80% of their beta-cell function [41, 42]. The available clinical studies with appropriate protocols, however, indicate that existing therapy may not reverse or arrest progression of beta-cell dysfunction in type 2 diabetes [40]. Weight loss reduces insulin resistance and beta-cell workload and physical activity increases insulin utilization and also helps to reduce beta-cell workload and bodyweight. Both help to normalize the blood glucose and are also useful for cardiovascular health. Promotion of physical activity and exercise and loss of excess bodyweight for as long as possible are the cornerstones of management in type 2 diabetes. Medications favoring these two aspects are preferred for as long as possible.

Hypoglycemia can manifest in different ways (**Figure 4**). Insulin is a known cause of hypoglycemia. The risk of hypoglycemia associated with the use of other antihyperglycemic medications

**Figure 3.** Factors to consider while prescribing antihyperglycemic medications in type 2 diabetes.

**Research perspectives:** Studies indicate that lower statin doses achieve lipid improvements in Chinese, Japanese and Koreans patients comparable with those observed with higher doses in Caucasians [33]. However as the mechanism of action of statins may not be just related to the lowering of LDL cholesterol, the relation of such observation with cardiovascular events need to be studied.
