A diagnosis of type 2 diabetes mellitus catches many people off guard. Perhaps you were in for a routine check-up, perhaps a raised HbA1c set things in motion. At that moment, big questions arise. What does this mean for your daily life? Do you need insulin straight away? How does your cardiovascular risk change? The good news: diabetes treatment has changed fundamentally over the past ten years. Today a combination of lifestyle and medication is available that lowers blood glucose while measurably protecting your heart, kidneys and life expectancy.
What modern diabetes treatment achieves today
What type 2 diabetes mellitus actually is
Human metabolism regulates blood glucose through the hormone insulin. Insulin allows glucose to pass from the blood into the body's cells. In type 1 diabetes mellitus, an autoimmune reaction destroys the insulin-producing beta cells of the pancreas, which is why insulin therapy is needed from the outset. This form typically appears in childhood or adolescence.
Type 2 follows a different course. It usually begins with insulin resistance. The body's cells respond less sensitively to insulin, so the pancreas ramps up production. Over the years this compensation wears out, leaving a relative insulin deficiency alongside the existing resistance. Risk factors are genetic predisposition, excess weight, lack of physical activity and metabolic syndrome [Schweizerische Diabetesgesellschaft 2024].
Every treatment starts with a precise diagnosis of the type. A thorough work-up uses HbA1c, fasting blood glucose, an oral glucose tolerance test and, in unclear cases, antibody testing to establish which type is present. This shapes all further treatment.
The building blocks of modern treatment
The Swiss recommendations of 2023 and the 2023 ESC guideline have fundamentally reorganised the treatment of type 2 diabetes. Instead of lowering blood glucose alone, the focus today is on a cardiometabolic approach that considers heart, kidneys and metabolism together [Lehmann R et al., Swiss Med Wkly 2023; Marx N et al., Eur Heart J 2023].
- Metformin remains the basic building block, proven over decades. It lowers hepatic glucose production, is inexpensive and well tolerated. UKPDS 33 first showed over the long term that intensive blood glucose control reduces microvascular complications [UKPDS Group, Lancet 1998].
- SGLT-2 inhibitors such as empagliflozin and dapagliflozin lower blood glucose via the kidneys. They additionally reduce cardiovascular events, hospitalisations for heart failure and deterioration of kidney function [Zinman B et al., NEJM 2015].
- GLP-1 receptor agonists such as liraglutide, semaglutide and dulaglutide act through several mechanisms: insulin release after meals, a feeling of satiety and weight reduction. They likewise reduce cardiovascular endpoints [Marso SP et al., NEJM 2016].
- Insulin is only used when combination therapy is no longer sufficient. In type 2 diabetes this typically happens only after years, often at an advanced stage.
- Continuous glucose monitoring (CGM) provides a seamless profile of daytime and night-time values. Ideally used with insulin therapy or with frequent hypoglycaemia, it is also gaining importance in patients on tablets alone.
- Lifestyle counts as part of the medical treatment rather than an optional extra. In the early stages, diet, exercise and weight reduction can lower HbA1c to a point where less medication is needed. :::
Since 2023, the SGED has explicitly recommended starting with a dual combination from the outset: metformin plus an SGLT-2 inhibitor, or metformin plus a GLP-1 receptor agonist [Lehmann R et al., Swiss Med Wkly 2023]. If that is not enough, a triple combination of metformin, SGLT-2 inhibitor and GLP-1 receptor agonist may be appropriate. The choice depends on concomitant conditions: in established heart failure or kidney failure, SGLT-2 inhibitors have advantages; in excess weight and atherosclerotic disease, GLP-1 receptor agonists are often the first choice.
Diabetes Chronic Care Management
In the consultation at Dein Team fürs Leben, your individual treatment plan is developed together with you. HbA1c trends, cardiovascular risk assessment, screening of eyes, kidneys and feet, and structured follow-up at your GP practice form the framework.
About the consultationLifestyle as part of the treatment
If you live with a diagnosis of type 2 diabetes, you have more influence through your lifestyle than with most other chronic diseases. A moderate weight reduction of five to ten percent can already lower HbA1c substantially. Regular physical activity improves insulin sensitivity directly in the muscle cells. A Mediterranean-style diet with vegetables, pulses, fish, olive oil and a reduced share of refined carbohydrates is the dietary pattern cited most often in the guidelines [Marx N et al., Eur Heart J 2023].
Realistically, lifestyle changes do not typically replace drug therapy. They make it more effective and often reduce the dose required. At the practice of Dein Team fürs Leben, this is planned together with you. Concrete steps, realistic goals and regular reviews replace blanket recommendations.
Chronic Care Management at the GP practice
Diabetes is a chronic disease that requires continuous follow-up. The central place for this is usually the GP practice. In concrete terms, structured Chronic Care Management means:
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- HbA1c every three to six months to monitor progress.
- Annual screening of the end organs: eyes (fundoscopy), kidneys (albuminuria, eGFR), feet (sensation, circulation), cardiovascular system.
- Blood pressure and lipid management as an integral component. In diabetes, every additional risk factor amplifies the cardiovascular burden [Marx N et al., Eur Heart J 2023].
- Medication review at regular intervals. Which substance is still helping, which can be reduced, which interactions matter with age.
- Training and patient education on the signs of hypoglycaemia, correct self-monitoring, medication when abroad and managing the disease.
- Interdisciplinary networking with diabetes counselling, dietary counselling, cardiology and endocrinology when the case requires it. :::
In the consultation at Dein Team fürs Leben, this Chronic Care Management is organised in a structured way, in close coordination between Prof. Dr. C.K. Fritz and Prof. Dr. Steffen Gloekler of Dein Team Herzzentrum.
When a specialist second assessment makes sense
Your GP covers most of diabetes treatment. In certain situations, an additional assessment by a diabetologist is advisable: unclear differentiation between type 1 and type 2, very young age at onset, gestational diabetes with particular requirements, complex insulin regimens, or recurring hypoglycaemia despite adjustments.
With accompanying cardiac symptoms (chest pressure, breathlessness, new-onset exhaustion), a cardiological assessment is part of the care. For diabetes, the 2023 ESC guideline recommends systematic cardiovascular risk assessment with SCORE2-Diabetes as the basis for treatment intensity [Marx N et al., Eur Heart J 2023]. The link to Dein Team Herzzentrum is a short one: joint discussion of findings, a shared treatment plan, and written feedback to the GP practice on the day of the examination.
Consultation at Dein Team fürs Leben
First contact without a referral. HbA1c, metabolic laboratory tests, cardiovascular assessment and treatment plan in a single session. For acute symptoms (severe weakness with nausea, clouded consciousness, breathlessness, chest pressure), dial 144.
Book a consultation appointment:::faq
Do I need insulin straight away after a diagnosis of type 2 diabetes?
In the vast majority of cases, no. The 2023 SGED recommendations provide for insulin therapy only when the combination of lifestyle, metformin, SGLT-2 inhibitor and GLP-1 receptor agonist does not reach the target range. In type 2 diabetes, this typically happens only after several years.
What is the difference between SGLT-2 inhibitors and GLP-1 receptor agonists?
SGLT-2 inhibitors act via the kidneys (glucose excretion in the urine), GLP-1 receptor agonists via the incretin system (insulin release after meals, satiety, weight reduction). Both reduce cardiovascular events, with different areas of emphasis. SGLT-2 inhibitors have particular advantages in heart failure and kidney failure, GLP-1 receptor agonists in excess weight and atherosclerotic disease.
How often should HbA1c be checked?
Usually every three to six months, depending on metabolic stability and adjustments to treatment. For stably controlled patients, a six-monthly interval may suffice; during treatment changes, closer checks are advisable.
Can I get rid of type 2 diabetes again?
A complete cure is generally out of reach in type 2 diabetes. Remission, however, is achievable. Substantial weight reduction (often ten percent or more) can lower HbA1c to the point where medication is no longer needed. The underlying predisposition remains, which is why the annual check-up is important even in remission.
Cost coverage: what does basic insurance pay for?
Basic diabetes care, HbA1c, the annual screening of the end organs and medication in line with the SGED guidelines are billed through compulsory basic health insurance (Grundversicherung). The practice reception handles billing via TARDOC, the Swiss outpatient tariff, and international direct billing where relevant.
Author: Prof. Dr. C.K. Fritz M.Sc., Physician Associate for General Internal Medicine, Pain Medicine, Practice Lead Dein Team fürs Leben.
