Treatment and follow-up in type 2 diabetes

The main objective is to prevent the development or worsening of arterial disease, retinopathy, nefropathy and neuropathy through a treatment strategy targeted at correctinghyperglycaemiadyslipidaemiahypertensionoverweight and lack of physical exerciseincreased coagulabilitysmoking.HbA1c target in pharmacological treatment is < 7.0% (53 mmol/mol), in non-pharmacological treatment normal HbA1c (4–6%, 20–42 mmol/mol).Less stringent target may be appropriate in patients with history of recurrent severe hypoglycaemiaslimited life expectancyadvanced vascular complicationssevere comorbid conditions.Treat hypertension aggressively (target level 130/80 mmHg).Target levels for lipids: HDL cholesterol > 1 in men, > 1.3 in women, triglycerides < 1.7, LDL cholesterol < 2.5 mmol/l.Prescribe ASA (100 mg) for all men over 50 years and women over 60 years of age, if they in addition to diabetes have at least one risk factor (coronary artery disease diagnosed in a relative before the age of 50 years, smoking, hypertension, dyslipidaemia, albuminuria) and if there are no contraindications for ASA. In younger patients, consider prescribing ASA if they in addition to diabetes have at least 2 cardiovascular risk factors .Even a slight decrease in body weight facilitates the management of risk factors.Encourage smokers to stop smoking.Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are essential causes of insulin resistance. The risk of NASH and of liver cirrhosis related to it is significantly increased.