The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have produced an updated consensus statement on how to manage hyperglycaemia in people with type 2 diabetes.
The consensus paper followed a review of the latest evidence, including a range of recent trials of drug and lifestyle interventions. It includes recommendations about specific drug classes for some people and enhancing medication adherence and also suggests that the delivery of patient-centred care should be prioritised, people with diabetes should have ongoing access to diabetes self-management education and support and healthy eating advice must be made available to all.
The new recommendations include:
- Providers and healthcare systems should prioritise the delivery of patient-centred care.
- Facilitating medication adherence should be specifically-considered when selecting glucose-lowering medications.
- All patients should have ongoing access to diabetes self-management education and support.
- Medical nutrition therapy (healthy eating advice and strategies) should be offered to all patients.
- All overweight and obese patients with diabetes should be advised of the health benefits of weight loss and encouraged to engage in a programme of intensive lifestyle management, which may include food substitution.
- Increasing physical activity improves glycaemic control and should be encouraged in all people with type 2 diabetes.
- 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 presence of cardiovascular disease, heart failure and kidney disease. The risk for specific adverse medication effects, particularly hypoglycaemia and weight gain; as well as safety, tolerability, and cost, are also important considerations.
- Regarding medication management, for patients with clinical 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. Individual agents within these drug classes have been shown to have cardiovascular benefits.
- 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.
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