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Additionally, dietary modification and oral enzyme replacement trials using synthetic sucrase (sacrosidase) have been employed to determine if they can clinically alleviate symptoms of sucrase-isomaltase deficiency [22, 23].
Different strategies to extinguish oral habits include behavior modification, and oral appliances.
Although treatment with dietary modification and oral antiglycemic agents may help initially, insulin will usually be required eventually.
Diet modification and oral hypoglycemic medications have proven inadequate, whereas insulin therapy only solves the problem temporarily.
In 2002, a randomized clinical trial (the Diabetes Prevention Project [DPP]) demonstrated that lifestyle modification and oral antihyperglycemics, specifically metformin, can delay or prevent progression to type 2 diabetes (3).
The two address different portions of the pathophysiological deficits in T2D, and each can safely and effectively help many patients to achieve recommended glucose targets when they are no longer able to do so with lifestyle modification and oral antidiabetic drugs (OADs) alone [ 15– 15].
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Many patients treated with lifestyle modifications and oral anti-diabetic drugs eventually require insulin therapy [ 1].
Although lifestyle modifications and oral hypoglycemic agents improve glycemic control, the majority of patients do not achieve the optimal glycohemoglobin (HbA1c) levels recommended by current guidelines (≤7.0%).
Previous Malaysian CPGs recommended that insulin should only be considered in patients with poor glycaemic control after lifestyle modifications and maximum oral glucose-lowering therapy [ 56].
This includes the provision of dietary education and counselling in the way of dietary modifications, food fortification and oral supplementation to ensure individual energy, protein and other nutrient requirements are achieved.
Any adverse events suggestive of heart disease will result in Rosiglitazone being discontinued and the patient moving to step 4. Life style modification and insulin therapy (oral agents will be stopped).
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