New Patient-Centric Guidelines for Type 2 DiabetesTuesday, April 24th, 2012
After several years of planning, discussion, and review, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have published a new position statement for managing elevated blood glucose levels in people with type 2 diabetes. Neither the ADA nor EASD had previously published an official position statement on this topic, instead providing a consensus treatment-based algorithm developed jointly by both groups.
The new guidelines are less rigid than those recommended in the treatment algorithm, and call for a more patient-centered approach that allows for individual patient needs, preferences, and tolerances and takes into account differences in age and disease progression. The need for a joint task force to review and revise the guidelines was driven by the complex and sometimes controversial nature of the agents used to manage glycemic control in patients with type 2 diabetes; the increasing array of pharmacologic agents now available and mounting concerns about their potential adverse effects, and new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications among certain populations. The position statement calls for providing all patients with diabetes education in either an individual or group setting that focuses on dietary intervention and the importance of increased physical activity and, when appropriate, weight management. The guidelines also encourage the development of individualized treatment plans built around a patient’s specific symptoms, comorbidities, age, weight, racial/ethnic/gender differences, and lifestyles.
Key points include:
- Glycemic targets and glucose-lowering treatments should be tailored to the individual patient.
- Diet, physical activity, and education remain the foundation of all diabetes treatment programs.
- Metformin should be the first-line medical treatment, unless otherwise contraindicated.
- Data are limited regarding treatment beyond metformin, but combination therapy with additional oral or injectable agents is reasonable and expected.
- HbA1c goal has been raised to 7%, with some individualization based on age, comorbidities, and patient motivation.
- A major treatment goal must be comprehensive cardiovascular risk reduction.
- Inzuchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Diabetes Care. 2012. Epub ahead of print. April 19, 2012. Full text available at: http://care.diabetesjournals.org/content/early/2012/04/17/dc12-0413.short. Accessed April 24, 2012.