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Treatment of Type 2 Diabetes

Lowering blood sugar alone is not enough. We treat according to the National Care Guideline — and look at weight, blood pressure, and sleep along with it.

Type 2 diabetes mellitus is a chronic disease characterized by progressive insulin resistance and beta cell dysfunction. Treatment is based on the National Care Guideline (NVL) Type 2 Diabetes[1] and is adapted to the individual situation — HbA1c targets, comorbidities, age, and functional capacity all play a role. It's not just about blood sugar, but also about preventing heart attacks, strokes, and kidney damage.

What treatment includes

  • Metabolic control: Individualized pharmacological therapy with HbA1c targets between 6.5 and 8.0% depending on patient situation
  • Weight reduction: Structured program according to S3 guideline (AWMF 050-001)[2] with BIA checks, nutritional counseling, and if needed, GLP-1 therapy
  • Cardiovascular risk reduction: Blood pressure control, lipid management, and reduction of thromboembolic events
  • Sleep medicine aspects: Screening for obstructive sleep apnea (OSA) as a risk factor for insulin resistance[3] and therapy failure
  • Prevention of complications: Early detection and prevention of nephropathy, neuropathy, retinopathy, and cardiovascular disease
Important Connection

The combination of obesity, sleep disorders, and diabetes requires diagnostics that consider these connections. The DiRECT study showed: with structured weight loss of 10–15 kg, 57% of participants achieved diabetes remission.[4] Therefore, isolated blood sugar reduction without considering weight and sleep is often insufficient.

References

  1. National Care Guideline (NVL) Type 2 Diabetes. German Medical Association (BÄK), Association of Statutory Health Insurance Physicians (KBV), AWMF. Version 3.0, 2023.
  2. S3 Guideline Obesity — Prevention and Therapy. AWMF Register No. 050-001, German Obesity Society (DAG), updated 2024.
  3. Reutrakul S, Van Cauter E. Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Metabolism. 2018;84:56–66.
  4. Lean MEJ, Leslie WS, Barnes AC et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391(10120):541–551.

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