Diabetes Treatment — What Actually Works
Diabetes treatment combines diet and activity change with medication chosen for your HbA1c, weight, kidney function and heart risk — metformin, SGLT2 inhibitors, GLP-1 agonists such as Ozempic or Mounjaro, or insulin. Most patients are reviewed every three months with HbA1c, and screened yearly for eye, kidney, nerve and cardiac complications.
A plain guide to diabetes treatment: how drugs are chosen, what HbA1c target to aim for, when insulin or a GLP-1 is right, and what remission of early Type 2 really involves. Written by the practice of Dr. Sanjay Sachdev (MBBS, MNAMS), South Delhi.
Step 1 — confirm the diagnosis properly
Fasting glucose, HbA1c and (where needed) an oral glucose tolerance test. Type 1 or slow-onset autoimmune diabetes is considered in lean or younger patients using antibody and C-peptide testing — misclassifying Type 1 as Type 2 is a common and costly error.
Step 2 — the non-drug base
Weight reduction of 7–15% where BMI allows, protein-forward meals with lower refined carbohydrate, 150 minutes of activity weekly plus twice-weekly resistance training, sleep of 7 hours, and alcohol limits. This base decides how few tablets you will eventually need.
Step 3 — choosing medication rationally
Metformin first-line for most. SGLT2 inhibitors where heart failure, kidney disease or albuminuria exist. GLP-1 receptor agonists (semaglutide, tirzepatide) where obesity or cardiovascular risk dominates. DPP-4 inhibitors for the frail elderly. Insulin when HbA1c is very high, during acute illness, or when beta-cell reserve is exhausted. Sulfonylureas only with hypoglycaemia counselling.
Step 4 — monitoring that changes decisions
HbA1c every 3 months until at target, then 6-monthly. Home glucose or CGM data reviewed at each visit for time-in-range, variability and nocturnal lows. Annual: urine albumin-creatinine ratio, kidney function, lipids, retina screening, foot and pulse examination, vitamin B12 for long-term metformin users.
Step 5 — remission of early Type 2
Where diagnosis is recent and beta-cell function preserved, a structured weight-loss programme — with GLP-1 support when indicated — can normalise sugars and allow a staged medication taper. Progress is measured on HbA1c and weight quarterly, and the plan is maintained, not stopped, once remission is reached.
Treatment in South Delhi
Diabetes care at Friends Colony East (C-58) and Maharani Bagh (E-64) — 45–60 minute first consultation, previous reports read in full, and a written plan with drug rationale, red flags, HbA1c target and next review date. Home sample collection available across South Delhi.
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