Editor's Message  |   January 2012
Be a “Great Physician” for Your Patients With Type 2 Diabetes Mellitus
Author Notes
  • Address correspondence to Jay H. Shubrook, Jr, DO, Associate Professor of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Grosvenor Hall, Athens, OH 45701-2979. E-mail:  
Article Information
Endocrinology / Diabetes
Editor's Message   |   January 2012
Be a “Great Physician” for Your Patients With Type 2 Diabetes Mellitus
The Journal of the American Osteopathic Association, January 2012, Vol. 112, Sii-Siii. doi:
The Journal of the American Osteopathic Association, January 2012, Vol. 112, Sii-Siii. doi:
Sir William Osler has been credited with saying, “The good physician treats the disease; the great physician treats the patient who has the disease.” With so many treatment options for patients with type 2 diabetes mellitus (T2DM), we now have the chance to truly select treatments to match each patient and thus provide optimal care. The more we learn about the pathophysiologic development of T2DM, the more we see the great number of systems and pathways involved in its pathogenesis, manifestations, and complications. 
As common as diabetes mellitus is in everyday practice, there continues to be shortcomings in treatment outcomes. Furthermore, this disease continues to progress on a slow but relentless course to be a leading cause of cardiovascular disease, end-stage renal disease requiring dialysis, legal blindness in adults, and nontraumatic limb amputations from neuropathy. It is estimated that 1 in 5 health care dollars in the United States is spent on patients with diabetes mellitus.1 
In the present supplement to JAOA—The Journal of the American Osteopathic Association, the expert team of authors explores newly understood pathophysiologic systems in diabetes mellitus and ways to address them. Jeffrey S. Freeman, DO, discusses the current understanding of the pathophysiologic characteristics of T2DM and how these characteristics change with the disease's progression.2 In addition, he explores the incretin effect in normal glucose metabolism and explains how defects in this pathway can lead to both fasting and postprandial hyperglycemia. Finally, Dr Freeman demonstrates how properly addressing this pathway not only improves glucose control, but also improves nonglycemic effects of diabetes mellitus and insulin resistance. 
Craig W. Spellman, DO, PhD, examines the current agents available to manage problems with the incretin system in patients with T2DM.3 He compares and contrasts these agents, helping to show where and when each medication would be most appropriate. He also reviews the current American Diabetes Association and American Association of Clinical Endocrinologists treatment guidelines and shows where the incretin agents fall within these regimens. 
James R. Gavin III, MD, PhD, discusses various patient-related issues related to these medications.4 He focuses on those factors that can help you decide which treatment to provide for your patient. Individualized treatment includes consideration of a patient's overall health status, comorbidities, concomitant medications, glucose control patterns, patient preferences, and even duration of disease. Dr Gavin explains how a busy physician can provide such individualized patient care. He also describes common adverse effects and warnings regarding incretin-based medications and reviews the safety data available for these agents. He introduces ways to review these medications with your patients and to communicate the most important factors for patients to know when taking these drugs. 
Finally, the authors use an illustrative case to exemplify how the material discussed in the present JAOA supplement can be applied to your daily practice.5 After reading this supplement, we hope you will have improved understandings of the pathophysiologic features of T2DM and of the incretin effect, as well as enhanced practical knowledge about the safety and efficacy of the incretin agents when applied to patients with T2DM. Moreover, with the help of the present supplement, you may be able to optimally provide individualized care that maximizes safety and efficacy and produces the desired glycemic and nonglycemic effects. We hope you can immediately apply the information gleaned from this supplement in your clinical practice. 
   Financial Disclosures: None reported.
American Diabetes Association. Economic costs of diabetes in the U.S. in 2007 [published correction appears in Diabetes Care. 2008;31(6):1271]. Diabetes Care. 2008;31(3):596-615. [CrossRef] [PubMed]
Freeman JS. Improving glucagon-like peptide-1 dynamics in patients with type 2 diabetes mellitus. J Am Osteopath Assoc. 2012;112(1 suppl 1);S2-S6. [PubMed]
Spellman CW. Incorporating glucagon-like peptide-1 receptor agonists into clinical practice. J Am Osteopath Assoc. 2012;112(1 suppl 1);S7-S15. [PubMed]
Gavin JRIII. Initiating a glucagon-like peptide-1 receptor agonist in the management of type 2 diabetes mellitus. J Am Osteopath Assoc. 2012;112(1 suppl 1);S16-S21. [PubMed]
Freeman JS, Gavin JRIII, Spellman CW. Common patient concerns about the use of glucagon-like peptide-1 receptor agonists in diabetes mellitus management. J Am Osteopath Assoc. 2012;112(1 suppl 1);S22-S24. [PubMed]