The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) has announced updated guidelines on how to manage hyperglycemia (high blood sugar) in patients with type 2 diabetes for healthcare professionals in the United States and Europe.
Some of the key points of the new recommendations include:
A Patient-Centered Approach
- Prioritizing the delivery of patient-centered care within the healthcare system and facilitating medication adherence when selecting glucose-lowering medications.
- Ensuring patients have ongoing access to diabetes self-management education and support as well as healthy eating strategies.
- Advising overweight and obese diabetes patients of weight loss and introducing lifestyle management tools, including advice on how to best substitute foods.
- Encouraging increasing physical activity to improve glycemic control.
- Recommended treatment options for adults with type 2 diabetes and (1) a BMI of 40 or over (or 37.5 or over in people of Asian ancestry) or (2) a BMI of 35.0 to 39.9 (32.5-37.4 kg/m2 in people of Asian ancestry) who do not achieve durable weight loss and improvement in comorbidities with reasonable non-surgical methods.
Under the recommendations, metformin continues to be the first-line recommended therapy for almost all patients with type 2 diabetes.
The selection of medication added to metformin is based on patient preference and clinical characteristics, including the presence of cardiovascular disease, heart failure, and kidney disease.
The risk of specific adverse medication effects, particularly hypoglycemia and weight gain; as well as safety, tolerability, and cost, are also important considerations.
As far as medication for patients with cardiovascular disease, a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended.
For patients with chronic kidney disease (CKD) or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit should be considered.
GLP-1 receptor agonists are generally recommended as the first injectable medication, except in settings where type 1 diabetes is suspected.
The EASD and ADA consensus paper concludes the management of hyperglycemia in type 2 diabetes has become extraordinarily complex with the number of glucose-lowering medications now available.
Patient-centered decision making, support and consistent efforts to improve diet and exercise remain the foundation of all glycaemic management,” they state. “Initial use of metformin, followed by addition of glucose-lowering medications based on patient comorbidities and concerns is recommended as we await answers to the many questions that remain.”