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Providers should prioritize patient-centered care for type 2 diabetes with treatment regimens tailored to the patient's specific goals, while new drugs to reduce cardiovascular risk should be introduced earlier for high-risk patients. risk, according to a consensus report released Friday by the American Diabetes Association and European Association for the Study of Diabetes.
Chantal Mathieu
"It has become a tradition – it's the third edition – to update the position statement, now renamed consensus report, every three years," Chantal Mathieu, MD, PhD, pProfessor of Medicine at the Katholieke Universiteit Leuven, Belgium, has Endocrine today. "The last statement was published in 2015. Given the evolution of literature and the accumulation of evidence on certain classes of agents, we were convinced that the time was right to give strong and evidence-based advice on the hypoglycemic treatment of type 2 diabetes. "
The updated guideline includes new evidence published between 2014 and February 2018, including studies of the efficacy or safety of pharmacological or non-pharmacologic interventions in adults with type 2 diabetes.
The recommendations include:
- Providers and health care systems should prioritize the delivery of care in patient centers.
- The ability to take medications as prescribed should be taken into account when choosing a specific hypoglycemic treatment for patients.
- SGLT2 inhibitors and GLP-1 receptor agonists are recommended for glycemic management in adults with established type 2 diabetes and CVD, whereas SGLT2 is recommended for patients with atherosclerotic CVD in whom Heart failure coexists or is a particular concern.
- An SGLT2 inhibitor that reduces the progression of chronic kidney disease should be considered in adults with type 2 diabetes and chronic renal failure, or a GLP-1 receptor agonist if SGLT2 inhibitors are against -indiqués.
- Bariatric surgery is a recommended treatment option for people with type 2 diabetes and a BMI of at least 40 kg / m² or with a BMI between 35 kg / m² and 39.9 kg / m² with other comorbidities.
- In adults needing the greatest hypoglycemic effect of an injectable drug, GLP-1 receptor agonists are the preferred choice of insulin.
The report also states that glycemic targets should be individualized based on the patient's preferences and goals, the risk of adverse treatment effects and patient characteristics, including frailty and comorbidities.
"The most important point is that the patient is at the center of his own therapy, his goal is to prevent complications, but especially to improve the quality of life," said Mathieu in conversation. "Lifestyle and multifactorial approaches are crucial and metformin should be present in all, if tolerated."
Some patient characteristics prevail over all other choices, based on tangible evidence, said Mathieu.
"If CVD is present, choose an SGLT2 inhibitor or a GLP-1 receptor agonist," she said. "If heart failure or chronic kidney failure is present, choose an SGLT2 inhibitor. If they are not present, let the other patient characteristics guide the choice of hypoglycemic treatments, such as the risk of hypoglycemia or the risk of weight gain. The cost is also a problem, with the proposed sulfonylureas and thiozoledinediones if the cost is in the foreground, with an intensification of education.
"We hope this consensus will help clinicians gain confidence when they choose hypoglycemic agents to treat people with type 2 diabetes," she said. The study was published simultaneously in both Diabetic treatments and diabetology. – by Regina Schaffer
The references:
Davies MJ, et al. Management of Hyperglycemia in Type 2 Diabetes: ADA-EASD 2018 Consensus Report. Presented at: Annual Meeting of the European Association for the Study of Diabetes; October 1 to 5, 2018; Berlin.
Davies MJ, et al. Diabetologia. 2018; doi: 10,1007 / s00125-018-4729-5.
Davies MJ, et al. Diabetic treatments. 2018; doi: 10.2337 / dci18-0033.
For more information:
Chantal Mathieu, MD, PhD, can be reached at Katholieke Universiteit Leuven, Oude Markt 13, 3000 Leuven, Belgium; E-mail: [email protected].
Disclosures: Davies indicates that she has received personal fees and / or grants from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Gilead Sciences, Intarcia, Janssen, Merck, Mitsubishi Tanabe Pharma Corp., Novo Nordisk, Sanofi and Takeda. . Please refer to the consensus report for the relevant financial information of other authors.
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