Badar uddin Abbasi.
Comparatiuve review of Oral Agent Therapy in the Treatment of Type II Diabetes.
Pak J Med Res Jan ;40(1):0-.

All patients newly diagnosed with type 2 diabetes should have an initial trial of diet and exercise therapy, except in cases of severe hyperglycemia (FBG >250 mg/dl or random blood glucose >400 mg/dl), which may require insulin therapy, at least on a temporary basis. If ADA glycemic guidelines are not achieved within 2-4 weeks, patients should begin therapy with an oral agent. As described above, choice of an oral agent is dictated by certain patient characteristics. In patients with abnormal liver function tests, all oral agents are contraindicated, necessitating insulin therapy. Patients with abnormal creatinine may use any oral hypoglycemic agent except metformin and the sulfonylurea chlorpropramide. In obese patients with creatinine <1.5 mg/dl, metformin should be considered as initial therapy. For nonobese patients, any oral hypoglycemic may be used.

If monotherapy fails, combination therapy can be initiated as discussed above. Despite the use of two-or three-drug combination therapy, some patients may not be able to achieve or maintain glycemic control consistent with ADA guidelines. For these patients, insulin therapy becomes necessary, either alone or in combination with oral agent therapy.

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