Diabetes clinical decision-making in patients at risk: Taking patient complexity into account

The sheer numbers of patients with type 2 diabetes, a chronic illness with multifactorial pathophysiology, common comorbidities, exacerbated by an obesity epidemic and a lack of specialists to care for them may seem daunting. However, new treatment options and treatment guidelines that take a more comprehensive and holistic approach to patient care are creating new opportunities to improve glycemic control. Today's approach to the patient with type 2 diabetes is a balancing act between appropriate glucose lowering while avoiding hypoglycemia. Fortunately, the development, introduction, and integration of incretin-based therapies (GLP-1 receptor agonists and DPP-4 inhibitors) into combination treatment strategies have reduced the risks of hypoglycemia and weight gain of more traditional treatment approaches. This review article explores these topics for the osteopathic family physician.