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New consensus on hyperglycaemia management in type 2 diabetes

By Colin Kenny, Editor – Diabetes Distilled

The American Diabetes Association and the European Association for the Study of Diabetes have published a new consensus guidance document on the management of type 2 diabetes in adults. The guidance does not take a target-driven approach, rather suggesting that patient factors and preferences should inform the process of individualising treatment goals and strategies. It points out that not all people living with diabetes should have the same level of diabetes control and that patient-centred care is vital. It also acknowledges that the goals of treatment for type 2 diabetes are to prevent or delay complications and maintain quality of life. 

The guidance begins by recommending lifestyle management, including medical nutrition therapy, physical activity, weight loss, counselling for smoking cessation and psychological support where needed. It continues to take a patient-centred approach to the medication management of glycaemia in adults with type 2 diabetes, aiming to reduce complications and maintain quality of life in the context of comprehensive cardiovascular risk management. It does not take a target HbA1c approach to treatment, but adopts an agreed treatment goal with the person living with diabetes.
 
Metformin remains the first-line hypoglycaemic medication. Medication is recommended for those with obesity alongside efforts targeting weight loss, including lifestyle, medication and surgical interventions. Suitable medications are recommended for people living with diabetes clinical cardiovascular disease. The guideline also proposes that people with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease receive special consideration. Recently-published evidence has resulted in glucagon-like peptide 1 (GLP-1) and sodium glucose cotransporter-2 (SGLT2) medications featuring prominently. The use of more cost-effective medications, when appropriate, is also outlined. 

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