25.6 : 糖尿病：管理と薬物療法

The goals of diabetes therapy include glycemic control, alleviating hyperglycemia-related symptoms, and preventing or reducing chronic end-organ complications.

Subcutaneous administration of insulin is the mainstay for the long-term treatment of all patients with type 1 and many patients with type 2 diabetes, leading to near-normal glycemia.

Glycemic control can be assessed by self-monitoring of blood glucose, continuous glucose monitoring, fructosamine measurement, and A1c test.

Comprehensive diabetes care also involves treating abnormalities in blood pressure and lipids and identifying and managing diabetes-related complications such as retinopathy, nephropathy, neuropathy, and cardiovascular diseases.

The nonpharmacologic aspects of diabetes therapy involve educating the patient about nutrition and exercise to lower plasma glucose.

In type 1 diabetes, matching caloric intake and insulin dosing is important, while in type 2 diabetes, the diet aims at weight loss and lowering blood pressure and atherosclerotic risk.