New strategies for the treatment of type 2 diabetes.

This review of current developments in the treatment of type 2 diabetes focuses on the achievement of normoglycemia through appropriately defined goals of diet, exercise, and drug therapy. Clinical nutritionists are central partners in the management of type 2 diabetes, and nutrition therapy is still considered the first-line therapy of choice. A nutritionist's role in the treatment at type 2 diabetes is to ensure an individualized, nutritionally adequate diet for patients, uncomplicated by episodes of hypoglycemia. In this role, clinical nutritionists must be aware of potential drug interactions with diet therapy and may be able to provide essential feedback about possible drug interactions to other members of the health care team, including nurses, pharmacists, and physicians. The role of insulin in treating type 2 diabetes is reexamined in the light of newly available oral antidiabetic agents and increasing awareness of the importance of insulin resistance and hyperinsulinemia in the development of diabetes complications. Because many patients use insulin to reduce blood glucose and glycated hemoglobin (HbA1c) to acceptable levels, management should combine diet therapy with insulin and/or 1 or 2 oral antidiabetic agents to help minimize the dose of exogenous insulin needed for glucose control.