ADA, EASD update consensus report on managing hyperglycemia in type 2 diabetes
Click Here to Manage Email Alerts
The American Diabetes Association and the European Association for the Study of Diabetes released an updated consensus statement on the management of hyperglycemia among adults with type 2 diabetes.
Robert A. Gabbay, MD, PhD, FACP, chief scientific and medical officer for the ADA, and colleagues convened a committee of experts appointed by the ADA and European Association for the Study of Diabetes (EASD) who conducted a systematic examination of randomized controlled trials, systematic reviews and meta-analyses on PubMed published between January 2018 and June 2022. Publications focused on social determinants of health, the health care system and physical activity behaviors related to hyperglycemia management in type 2 diabetes.
The update, published in Diabetes Care, focused on various guidance on care:
- People with type 2 diabetes should be offered access to Diabetes Self-Management Education and Support programs.
- Providers and health care systems should prioritize person-centered care.
- Early combination therapy should be considered for people with diabetes younger than 40 years.
- Among women with reproductive potential, it is important to conduct counseling on contraception and avoid medication exposure that may adversely affect a fetus.
Other recommendations focused on weight loss and physical activity:
- Medical nutrition therapy should focus on identifying health dietary habits that are feasible and sustainable to support reaching metabolic and weight goals.
- Physical activity should be considered essential in type 2 diabetes management.
- Adults with type 2 diabetes should complete regular physical activity goals of more than 150 minutes per week of moderate to vigorous aerobic activity, reduce their sedentary time and take frequent activity breaks.
- People with type 2 diabetes should supplement aerobic activity with two to three resistance, flexibility and/or balance training sessions per week.
- Metabolic surgery should be considered as a treatment option for adults with a BMI of 40 kg/m2 or more or a BMI of 35 kg/m2 to 39.9 kg/m2 for those who do not achieve durable weight loss and improvement in their comorbidities with nonsurgical methods.
The update also touched on recommendations extending SGLT2 inhibitor medications:
- Optimize medication adherence when selecting glucose-lowering medications.
- Use GLP-1 receptor agonists or SGLT2 inhibitor medications to reduce major adverse cardiovascular events and heart failure and improve kidney outcomes for people with established cardiovascular disease and people without established CVD but with multiple CV risk factors.
- Initiate SGLT2 inhibitor medications to reduce major adverse CV events and heart failure and improve kidney outcomes for people with chronic kidney disease and an estimated glomerular filtration rate of 20 mL/min/1.73 m2 or more and a urine albumin-creatinine ratio of more than 3 mg/mmol.
- Use SGLT2 inhibitors for people with heart failure.
- The decision to use a GLP-1 receptor agonist or SGLT2 inhibitor should be independent of background metformin use and independent of baseline HbA1c for people with heart failure, CKD, established CVD or multiple CVD risk factors.
- Medication selections to improve CV and kidney outcomes should not differ for older people.
To implement these updated recommendations, the authors of the consensus statement noted the importance of acknowledging the lifelong and evolving nature of diabetes, identifying and coordinating with the health care team, knowing local resources and being aware of language use in diabetes care. In addition, clinicians should consider each person with diabetes an individual with specific context, risks and preferences. Health care systems should monitor and address inequalities in type 2 diabetes, assess and address social determinants of health, and incorporate comorbidities when developing and implementing management plans.
According to Gabbay, it is important for future research to assess how to extend the benefits of treatment to all patients and reduce health inequities along with exploring more about the needs of different patient subgroups to manage other comorbidities.
For more information:
Robert A. Gabbay, MD, PhD, FACP, can be reached at @DrBobGabbay.
Reference:
ADA/EASD consensus update on management of hyperglycemia in type 2 diabetes – report published in Diabetes Care. Published Sept. 23, 2022. Accessed Sept. 23, 2022.
Collapse
Read more about
Click Here to Manage Email Alerts