Management of type 2 diabetes focuses on lifestyle interventions, lowering other cardiovascular risk factors, and maintaining
blood glucose levels in the normal range. Self-monitoring of blood glucose for people with newly diagnosed type 2 diabetes may be used in combination with education, although the benefit of self-monitoring in those not using multi-dose insulin is questionable. Managing other cardiovascular risk factors, such as
hypertension,
high cholesterol, and
microalbuminuria, improves a person's life expectancy. Intensive blood pressure management (less than 130/80 mmHg) as opposed to standard blood pressure management (less than 140–160 mmHg systolic to 85–100 mmHg diastolic) results in a slight decrease in stroke risk but no effect on overall risk of death. Intensive blood sugar lowering (HbA1c 1c of 7–7.9%) does not appear to change mortality. The goal of treatment is typically an HbA1c of 7 to 8% or a fasting glucose of less than 7.2 mmol/L (130 mg/dL); however these goals may be changed after professional clinical consultation, taking into account particular risks of
hypoglycemia and life expectancy. Hypoglycemia is associated with adverse outcomes in older people with type 2 diabetes. Despite guidelines recommending that intensive blood sugar control be based on balancing immediate harms with long-term benefits, many people – for example people with a life expectancy of less than nine years who will not benefit, are
over-treated. It is recommended that all people with type 2 diabetes get regular
eye examinations.
Lifestyle Exercise A proper diet and regular
exercise are foundations of diabetic care, Regular exercise may improve blood sugar control, decrease body fat content, and decrease blood lipid levels.
Diet Calorie restriction to promote weight loss is generally recommended. Around 80 percent of obese people with type 2 diabetes achieve complete remission with no need for medication if they sustain a weight loss of at least , but most patients are not able to achieve or sustain significant weight loss. Several diets may be effective such as the
DASH diet,
Mediterranean diet,
low-fat diet, or
monitored carbohydrate diets such as a
low carbohydrate diet. Other recommendations include emphasizing intake of fruits, vegetables, reduced saturated fat and low-fat dairy products, and with a macronutrient intake tailored to the individual, to distribute calories and carbohydrates throughout the day. A 2021 review showed that consumption of tree nuts (
walnuts,
almonds, and
hazelnuts) reduced fasting blood glucose in diabetic people. , there is insufficient data to recommend nonnutritive sweeteners, which may help reduce caloric intake. An elevated intake of
microbiota-accessible carbohydrates can help reducing the effects of T2D.
Viscous fiber supplements may be useful in those with diabetes. Culturally appropriate education may help people with type 2 diabetes control their blood sugar levels for up to 24 months. There is not enough evidence to determine if lifestyle interventions affect mortality in those who already have type 2 diabetes. A
Cochrane review is under way to assess the effects of
mindfulness‐based interventions for adults with type 2 diabetes.
Medications Blood sugar control There are several classes of
diabetes medications available.
Metformin is generally recommended as a first line treatment as there is some evidence that it decreases mortality; however, this conclusion is questioned. Metformin should not be used in those with severe kidney or liver problems. The higher cost of these drugs compared to metformin has limited their use. Other classes of medications include:
sulfonylureas,
thiazolidinediones,
dipeptidyl peptidase-4 inhibitors,
SGLT2 inhibitors, and
GLP-1 receptor agonists.
Rosiglitazone, a thiazolidinedione, has not been found to improve long-term outcomes even though it improves blood sugar levels. Additionally it is associated with increased rates of heart disease and death.
Injections of insulin may either be added to oral medication or used alone. and do not appear much better than
NPH insulin, but as they are significantly more expensive, they are not cost effective as of 2010. In those who are
pregnant, insulin is generally the treatment of choice. However, there is only limited evidence regarding what the lower targets should be. A 2016 systematic review found potential harm to treating to targets lower than 140 mmHg, and a subsequent review in 2019 found no evidence of additional benefit from blood pressure lowering to between 130 and 140 mmHg, although there was an increased risk of adverse events. 2023 European Society of Cardiology guidelines recommend systolic blood pressure lowering to 130 mmHg in most people with diabetes. In people with diabetes and
hypertension and either
albuminuria or
chronic kidney disease, an inhibitor of the renin-angiotensin system (such as an
ACE inhibitor or
angiotensin receptor blocker) to reduce the risks of progression of kidney disease and present cardiovascular events. There is some evidence that
angiotensin converting enzyme inhibitors (ACEIs) are superior to other inhibitors of the renin-angiotensin system such as
angiotensin receptor blockers (ARBs), or
aliskiren in preventing cardiovascular disease. Although a 2016 review found similar effects of ACEIs and ARBs on major cardiovascular and renal outcomes. There is no evidence that combining ACEIs and ARBs provides additional benefits. The use of
aspirin (acetylsalicylic acid) to prevent cardiovascular disease in diabetes is controversial. Aspirin as
primary prevention may have greater risk than benefit, but could be considered in people aged 50 to 70 with another significant cardiovascular risk factor and low risk of bleeding after information about possible risks and benefits as part of shared-decision making. Sharing their
electronic health records with people who have type 2 diabetes helps them to reduce their blood sugar levels. It is a way of helping people understand their own health condition and involving them actively in its management.
Surgery Weight loss surgery in those who are
obese is an effective measure to treat diabetes. Many are able to maintain normal blood sugar levels with little or no medication following surgery and long-term mortality is decreased. The
body mass index cutoffs for when surgery is appropriate are not yet clear. It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control. ==Epidemiology==