{"id":4600,"date":"2018-10-31T18:24:27","date_gmt":"2018-10-31T22:24:27","guid":{"rendered":"https:\/\/www.med.unc.edu\/medicine\/diabetes-experts-release-new-guidelines-for-hyperglycemia-in-type-2-diabetes\/"},"modified":"2023-06-06T17:23:23","modified_gmt":"2023-06-06T21:23:23","slug":"diabetes-experts-release-new-guidelines-for-hyperglycemia-in-type-2-diabetes","status":"publish","type":"post","link":"https:\/\/www.med.unc.edu\/medicine\/news\/diabetes-experts-release-new-guidelines-for-hyperglycemia-in-type-2-diabetes\/","title":{"rendered":"Diabetes Experts Release New Guidelines for Hyperglycemia in Type 2 Diabetes"},"content":{"rendered":"

<\/p>\n

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John Buse, MD, PhD<\/figcaption><\/figure><\/figure>\n<\/div>\n
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(Republished from the UNC Health Care and UNC School of Medicine Newsroom)<\/em><\/p>\n

New recommendations, co-written by UNC School of Medicine\u2019s John Buse, MD, PhD, cover the type of drugs patients should be prescribed and how providers can better help patients manage their health.<\/p>\n

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 (high blood sugar) in patients with type 2 diabetes. The consensus paper<\/a> is being published in the EASD\u2019s journal, Diabetologia<\/i>, and the ADA\u2019s journal, Diabetes Care<\/i>. This publication coincides with the EASD annual meeting in Berlin, Germany.<\/p>\n

The new recommendations from an expert panel of EASD and ADA members follow a review of the latest evidence \u2014 including a range of recent trials of drug and lifestyle intervention \u2014 and update the last recommendations issued in 2015.<\/p>\n

UNC School of Medicine\u2019s John Buse, MD, PhD, senior author of the paper and co-chair of the ADA consensus statement writing group, says there are two key changes in the updated recommendations.<\/p>\n

\u201cWe have suggested changing the focus of why drugs are prescribed to patients. Instead of primarily focusing on lowering blood sugar, we now suggest physicians primarily focus on treatment to prevent heart attack, stroke, heart failure and kidney disease,\u201d said Buse, director of the UNC Diabetes Care Center and director of the NC Translational and Clinical Sciences (NC TraCS<\/a>) Institute.<\/p>\n

The new recommendations say type 2 diabetes patients with clinical cardiovascular disease should take a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium-glucose cotransporter 2 (SGLT2) inhibitor. Buse says they also now recommend that if a patient needs to take an injection, they should start with a GLP-1 receptor agonist instead of insulin, which has been the classical approach. There is also more focus on diet, weight loss medications, and weight loss surgery as strategies for diabetes control.<\/p>\n

\u201cLess than 20 percent of patients in the U.S. are getting the recommended treatments,\u201d Buse said. \u201cI do not know how much these new recommendations will change provider behavior or insurance coverage, but we do believe it is absolutely the right way to approach treatment in these patients.\u201d<\/p>\n

Following are more details on the new recommendations.<\/p>\n

\u2022 Providers and health care systems should prioritize the delivery of patient-centered care.<\/p>\n

\u2022 Facilitating medication adherence should be specifically considered when selecting glucose-lowering medications. (Ultimately, patient preference is a major factor driving the choice of medication. Even in cases where a patient\u2019s clinical characteristics suggest the use of a particular medication based on the available evidence from clinical trials, patient preferences regarding route of administration, injection devices, side effects or cost may prevent their use by some individuals.)<\/p>\n

\u2022 All patients should have ongoing access to diabetes self-management education and support.<\/p>\n

\u2022 Medical nutrition therapy (healthy eating advice and strategies) should be offered to all patients.<\/p>\n

\u2022 All overweight and obese patients with diabetes should be advised of the health benefits of weight loss and encouraged to engage in a program of intensive lifestyle management, which may include food substitution.<\/p>\n

\u2022 Increasing physical activity improves glycemic control and should be encouraged in all people with type 2 diabetes.<\/p>\n

\u2022 Metabolic surgery is a recommended treatment option for adults with type 2 diabetes and a BMI of 40 or over (or 37.5 or over in people of Asian ancestry) or a BMI of 35.0 to 39.9 (32.5\u201337.4 kg\/m2 in people of Asian ancestry) who do not achieve durable weight loss and improvement in comorbidities with reasonable non-surgical methods.<\/p>\n

\u2022 Metformin continues to be the first-line recommended therapy for almost all patients with type 2 diabetes.<\/p>\n

\u2022 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 hypoglycemia, weight gain, safety, tolerability, and cost, are also important considerations.<\/p>\n

\u2022 Regarding medication management, for patients with clinical cardiovascular disease, a sodium\u2013glucose 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.<\/p>\n

\u2022 For patients with chronic kidney disease (CKD) or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit should be considered.<\/p>\n

\u2022 GLP-1 receptor agonists are generally recommended as the first injectable medication, except in settings where type 1 diabetes is suspected.<\/p>\n

\u2022 Intensification of treatment beyond dual therapy to maintain glycemic targets requires consideration of the impact of medication side-effects on comorbidities, as well as the burden of treatment and cost.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

<\/p>\n

New recommendations, co-written by UNC School of Medicine\u2019s John Buse, MD, PhD, cover the type of drugs patients should be prescribed and how providers can better help patients manage their health.<\/p>\n","protected":false},"author":69419,"featured_media":4601,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","footnotes":"","_links_to":"","_links_to_target":""},"categories":[96,2],"tags":[22],"class_list":["post-4600","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-endocrinology-metabolism","category-news","tag-22","odd"],"acf":[],"yoast_head":"\nDiabetes Experts Release New Guidelines for Hyperglycemia in Type 2 Diabetes | Department of Medicine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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