Updated ADA/EASD guidance on hyperglycaemia on the way
The treatment approach to type 2 diabetes should begin with an assessment of cardiovascular disease (CVD) status, other comorbidities, and patient preferences, according to a draft of the upcoming 2018 joint consensus statement from the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD). A preview of the draft document was presented in a symposium at the American Diabetes Association (ADA) 2018 Scientific Sessions.
The final version of the 2018 update to the current 2015 ADA/EASD Management of Hyperglycemia in Type 2 Diabetes statement (Diabetes Care 2015;38:140-149) will be presented on 5 October at the EASD annual meeting in Berlin and published in Diabetes Care and Diabetologia.
Dr John Buse from the University of North Carolina said, “We are taking a new look at hyperglycaemia based on the many studies conducted since 2014, particularly the cardiovascular outcomes trials.” The statement will aim to help clinicians navigate the increasingly complex options for management of hyperglycaemia in type 2 diabetes, with particular emphasis on data published since 2014, including those suggesting cardiovascular benefit for the sodium-glucose cotransport-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists.
Co-author Dr Judith Fradkin of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, Maryland said, "The focus of this consensus report is not on what an individual's glycaemic target should be or on how to select individualized goals, but rather how to achieve the individual patients' glycaemic target taking into account patient factors and the ever-increasing choice of therapies available for glycaemic control."
The draft document still recommends metformin as first-line therapy, but now favours the injectable GLP-1 agonists or SGLT2 inhibitors as second-line therapy over insulin, depending on underlying patient characteristics and other issues such as affordability/accessibility of the drugs.
The document also includes some good practical advice for primary care physicians, who increasingly have to manage type 2 diabetes. This will include a graphic clearly indicating which type 2 diabetes agents should be stopped, or have their doses reduced, when therapy is intensified.