Running Head: Pharmacological Management of Type 2 Diabetes Mellitus 1

Pharmacological Management of Type 2 Diabetes Mellitus

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Pharmacological Management of Type 2 Diabetes Mellitus 2

Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus(T2DM) is a deady metabolic condition thatthat that stems from

insulin resistance that leads to hyperglycemia, impaired secretion of insulin, and hike in the

amount of glucose produced in the body, which causes blood sugars rise too high.This condition

is influenced by factors like obesity, genetic history, and lack of exercise and can be managed

through blood sugar monitoring, healthy lifestyle habits, d medication.The commonness of type

2 diabetes mellitus has been on the rise, necessitating the need for further treatment,

management, and containment of the disease, whereby advanced practice nurses play an integral

role.

Pathophysiology of Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus develops when genetic and environmental factors interplay,

leading to insuli resistance.This is whereby skeletal muscles, adipose tissues, and the liver

become less responsive to the effects of insulin in the body (Szablew ki, 2024).This causes a

reduction in the amount of insulin taken up by cells and results in hype lycemia. Factors

contributing to insulin resistance include obesity-related inflammation and genetic predisposition

(Galicia-Garcia et al. 2020). Additionally, the liver adds to the hyperglycemia by increasing

gluconeo nesis. Thereafter, the pancreatic beta cells, responsible for insulin secretion, lose the

ability to secrete surplus insulin, which should overcome insulin resistance his state of

progressive beta cell dysfunction is fueled by factors such as excess fatty acids, which lead to

lipotoxicity, chronic exposure to high glucose levels, leading to glucotoxicity, and genetic facto .

Additionally, in T2DM, the liver fails to produce glucose effectively, more so during night

periods and after meal intakes, and increased hepatic glucose output intensifies hyperglycemia

This causes the need for disease management.

Pharmacological Agents for Type 2 Diabetes Mellitus Management

Managing T2DM involves the using use of several classes of medications that aim to

achieve a goal of close to normal glucose levels and reduced risk of disease complications.

First, Biguanides, specifically metformin, as a pharmacological agent for type 2 diabetes

mellitus, the first-line remedy. Metformin works by reducing the production of hepatic

glucose and improving the sensitivity of in lin in peripheral tissues. Additionally, t enables one

to lose weight. However, nurses should note that metformin should be administered in

combination with other lifestyle interventions unless it is contra-indicated (Chawla et al., 2020)

and with gradual doses to minimize common gastrointesti l side effects,,, such as diarrhea and

nausea. The contraindications for this drug are in patients who have severe renal mpairment

because of the risk of lactic acidosis. Advanced Practice Nurses (APNs) should closely

monitor the renal functioning of patients who have taken

metforminmetforminmetforminmetformin to avoid the the the the risk of complications from the

drug.

The second class of Pharmacological Agents for type 2 diabetes mellitus

management remedies is sulfonylureas, with examples of glipizide, gliclazide, glyburide,

glimepiride, which which which facilitate stimulation of insulin release from fromfromfrom the

pancreatic beta cells. These drugs are effective for lowering the b od glucose level but bear

risks of hypoglycemia, most likely in aged patients, renal impairment patients, and hepatic

patients. Since weight gain is a common side effect of these drugs, it is less desirable in obese

patients (Jun Sung Moon et al., 2024).Advanced practice nurses should educa patients taking

this drug on the signs and symptoms of hypoglycemia and advise them to check their blood sugar

levels constantly. The third class of pharmacological agents for type 2 diabetes mellitus is
Pharmacological Management of Type 2 Diabetes Mellitus 4

thiazolidinediones, th examples of pioglitazone and rosiglitazone, which effectively impro

insulin sensitivity in adipose tissues and skeletal muscles. These dru s are also effective in

reducing hepatic glucose production. However, the side effects of this drug are fluid retention

and weight gain. Therefore, Advanced practiced nurses are advised to contraindicate the drug for

patients with congestive heart failure to avoid the risk of complications.

Additionally, dipeptidyl peptidase-4 (DPP-4) inhibitors like sitagliptin, linagliptin, alo

iptin and Saxagliptin Saxagliptinprolong the incretin hormone action, which stimulates the

release of insulin and suppress the secretion of glucagon. APNs should consi r the fact that

these drugs have been associated with rare cases of pancreatitis and that Saxagliptin

Saxagliptinmay elevate the risks of heart failure. Another remedy is the sodium-glucose

cotransporter-2(SGLT-2) inhibitors, with examples of canagliflozin, empagliflozin and

dapagliflozin, which work by preventing glucose reabsorption in the proximal renal tubule,

resulting in increased excretion of glucose in the urine. These agents also present with

cardiovascular and renal benefits. However, nurses should educate patients on the risks of

increased urinary tract infections and genital fungal infections and encourage them to monitor for

signs and symptoms to promote early detection and treatment.

Insulin therapy, as a remedy for type 2 Di etes mellitus (Ke et al., 2021), is often required

for patients experiencing severe hyperglycemia, progressive beta-cell failure, or those who fail

oral erapy. There are various insulin preparations, such as short, long, intermediate and rapid-

acting insulins. Advanced practice nurses should consider that these regimens should be

personalized to accommodate patient preferences, financial abilities, and medical conditions,

besides educating the patients on the appropriate regimens, insulin administration, how to adjust

dosages, and how to prevent hypoglycemia. Lastly, glucagon-like peptide-1(GLP-1) receptor

agonists, with examples of canagflozin, dapagliflozin, empagliflozin, and ertugliflozin, mi c the

effects of hormone incretin by stimulating the release of insulin, suppressing the secretion of

glucagon and slowing down the emptying of gastric. These drugs also promote weight loss

and have cardiovascular benefits. Advanced practiced nurses should also consider the fact that

these drugs are beneficial for overweight patients and recommend them to patients who are

obese, their typical side effects which include vomiting and nausea, and that Semaglutide has

been found to reduce cardiovascular risk.

Role of the Advanced Practice Nurse in T2DM Management

Advanced Practice Nurses are crucial in managing type 2 abetes mellitus by upholding

specific responsibilities. For instance, conducting a thorough assessment of patients suffering

from type 2 di etes mellitus, and collecting data regarding their medical history, physical

examination, and laboratory findings will help determine the care ven to them. Secondly, they

also tailor medication based on patient needs and specific factors like age, financial restraints ,

preferences and comorbidities. Once they consider all these considerations, they can prescribe

and adjust medications for Type 2 diabetes mellitus patients. For obese patients and those

undergoing medication, Advanced practice nurses take part in counseling regarding healthy

lifestyle habits like exercising, eating nutritious foods, balanced dieting and how to manage their

weight.

Additionally, Advanced practice nurses ought to provide comprehensive education to

patients about their conditions, how to self-monit , manage their medication, and prevent

complications. Alternatively, Advanced practice nurses collaborate with other medical

practitioners, such as dietitians and ophthalmologists, to provide cumulative care to their patients

with Type 2 diabetes mellitus. Above all, Advanced practice rses regularly monitor their paa
Pharmacological Management of Type 2 Diabetes Mellitus 6

patientsregularly monitor their patientsregularly monitor their patients to observe medication r

ponse, side effects, glycemic control, and co, and complications. Their role in the

management of type 2 diabetes mellitus management is vital.

In conclusion, the pharmacological management of type 2 diabetes mellitus has evolved

and improved overover medicatio,n that target various pathophysiological mechanisms being

invented.To achieve an effective pharmacological management of type 2 diabetes mellitus

condition, a varied approach should be embraced. Advanced practice nurses play an important

role in providing care to the patients affected by this condition in various ways, including

managing their medication, educating them regarding the conditions and how to manage or

contain situations arising from their conditions, counseling them on appropriate lifestyle habits

and dietary preferences which go hand in hand with effec ve management of Type 2 diabetes

mellitus. Additionally, supposethey should stay informed on the latest advancements in ways to

manage diabetes. In that case,. In that case, Advanced practice nurses can help patients reduce

the the the the the the risk of long-term complications and obtaining achievement of glycemic

control.This can be achieved by developing training workshops every once in while, where

Advanced practice nurses are taught about upcomi and improved ways to take care of their

patients. Centering patient care to fit individual patient needs and preferences leads to the

successful management of type 2 diabetes mellitus as patients coo rate more easily with their

treatment and diet plans.

Ref ences

Chawla, R., Madhu, S. V., Makkar, B. M., Ghosh, S., Saboo, B., Kalra, S., & RSSDI-ESI Consensus

Group. (2020). RSSDI-ESI C nical Practice Recommendations for the Management of Type

2 Diabetes Mellitus 2020. Indian Journal of Endocrinology and Metabol m, 24(1), 1–122.

https://doi.org/10.4103/i m.IJEM_225_20

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., …

Martin, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International Journal

of Molecular Sciences, 21(1 , 1–34. https://doi.org/10.3390/ijms 176275

Jun Sung Moon, Kang, S., Jong Han Choi, Kyung Ae Lee, Joon Ho Moon, Chon, S., … Hae Jin

Kim. (2024). 2023 linical Practice Guidelines for Diabetes Management in Korea: ll

Version Recommendation of the Korean Diabetes Association. Diabetes & Metabolism

Journal, 48(4), 546–708. https://doi.org/10.4093/dmj.2024.0249

Ke, J.-F., Wang, J.-W., Zhang, Z.-H., Chen, M.-Y., Lu, J.-X., & Li, L.-X. (2021). Insulin Therapy

Is Associated With an Increased Risk of Carotid Plaque in Type 2 Diabetes: A Real-World

Study. Frontiers in Cardiovascular Medicine, 8.

https://doi.org/10.3389/fcvm.2021.599545

Szablewski, L. (2024). Changes in Cells Associated with Insulin Resistance. International

Journal of Molecular Sciences, 25(4), 2397–2397.

https://doi.org/10.3390/ijms25042397