New EASD-ADA Consensus Guidelines on the Management of Hyperglycemia in Type 2 Diabetes Launched at the EASD Meeting

The new recommendations from the group of experts from both companies, which update their previous 2015 guidelines, include:

• Providers and health systems must prioritize the provision of patient-centered care
• Facilitating adherence should be specifically considered when selecting hypoglycemic drugs. (Ultimately, patient preference is a determining factor in the choice of the drug, even in cases where the clinical features of a patient suggest the use of a particular drug based on available evidence from the trials. clinical, patient's preferences regarding route of administration, injection devices, effects or cost may prevent their use by some people)
• All patients should have ongoing access to diabetes management education and support
• Medical nutrition therapy (advice and strategies for healthy eating) should be offered to all patients.
• All obese or overweight diabetic patients should be informed of the health benefits of weight loss and encouraged to engage in an intensive lifestyle management program, which may include dietary substitution.
• The increase in physical activity improves glycemic control and should be encouraged in all people with type 2 diabetes.
• Metabolic surgery is a recommended treatment option for adults with type 2 diabetes and (1) a BMI greater than or equal to 40 (or 37.5 or higher in people of Asian descent) or (2) ) a BMI between 35.0 and 39.9 (32.5-37.4 kg / m2 in persons of Asian origin) who fail to achieve sustained weight loss or improvement in comorbidities with reasonable non-surgical methods.
• Metformin remains the recommended first-line therapy in almost all patients with type 2 diabetes
• The choice of drug added to metformin depends on the patient's preferences and clinical characteristics, including the presence of cardiovascular disease, heart failure and kidney disease. The risk of drug-specific side effects, especially hypoglycemia and weight gain; as well as safety, tolerability and cost, are also important considerations.
• With regard to drug management, patients with clinical cardiovascular disease are advised to use a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a glucagon-like peptide 1 (GLP-1) agonist. ) has proven cardiovascular benefit. Individual agents belonging to these classes of drugs have been shown to have cardiovascular benefits.
• For patients with chronic renal failure (CRF) or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with demonstrated benefits should be considered.
• GLP-1 receptor agonists are generally recommended as the first injectable drug except in settings where type 1 diabetes is suspected
• Intensification of treatment beyond dual therapy to maintain glycemic goals requires taking into account the impact of drug side effects on comorbidities, as well as the burden of treatment and its cost

The panel said the lack of evidence regarding specific combinations of hypoglycemic treatments remained a problem and further research was needed. The saying goes: "As the costs are enormous for these different approaches, we are in desperate need of evidence – different models of care are being implemented globally – the definition of cost-effective optimal approaches to care, particularly for patient burden – morbidity is essential. "

They add: "New issues stem from recent studies on cardiovascular effects.The cardiovascular and renal benefits of SGLT2 inhibitors and GLP-1 receptor agonists demonstrated in patients with established cardiovascular disease are important." do they extend to patients at lower risk? -1 Receptor agonists and SGLT2 inhibitors for the prevention of cardiovascular and renal events? If yes, in which populations? Answering these vital clinical questions will require additional investments in the basic, translational, clinical and implementation research. "

They conclude, "The management of hyperglycemia in type 2 diabetes has become extremely complex with the number of hypoglycemic drugs available.The patient-centered decision-making process, its support and constant efforts to improve its diet and its exercises remain the foundation of any glycemic management.The initial use of metformin, followed by the addition of hypoglycemic drugs based on the comorbidities and concerns of the patient, is recommended pending responses to many issues still to be resolved. "

Explore further:
Study: Improving glycemic parameters by adding dapagliflozin to metformin in T2DM