ADA, EASD Release Update on Management of Hyperglycemia in Type 2 Diabetes

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) announced on Friday, September 23, 2022 the release of new consensus recommendations for the management of hyperglycemia in type 2 diabetes (T2D).

The latest update to the joint guidelines focuses on a more holistic, person-centred approach to caring for people with T2D, including an appreciation for equity in care.

According to the introduction, the update is based on a systematic review of the evidence published since 2018. Based on the analysis, the new recommendations include a new focus on social determinants of health and the role of the entire health system in disease management of T2D. The former, the statement said, are often beyond the control of the individual and potentially pose a lifelong risk that needs to be factored into decisions about care.

Lifestyle. There is also an expanded focus on the role of lifestyle changes in managing hyperglycemia and maintaining optimal health, including additional guidance on physical activity, e.g. B. daily light exercise or resistance training every 30 minutes while seated, achieving an additional 500 steps per day, strength training 2-3 times per week and the importance of sleep quantity (6-9 hours/night) and quality.

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weight management. There is a significantly deepened and broadened focus on weight management as a central element in the management of hyperglycemia, as well as to mitigate and/or prevent known T2D comorbidities, e.g. liver disease. Weight reduction in the consensus statement is viewed as a targeted intervention, and a 5 to 15% loss should be a primary treatment goal for many people with T2D, the authors write.

cardio-renal protection. A number of expanded recommendations for cardio-renal protection in T2D patients at increased risk for both types of cardiometabolic diseases are based on clinical studies and in particular studies on cardiovascular and renal outcomes with sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon similar peptides. 1 receptor agonists (GLP-1 RA), including the assessment of important patient subpopulations. Other updates include recommendations on the use of oral GLP-1 RAs, guidance on the new class of dual GIP/GLP-1 RAs, and appropriate use of combined GLP-1 RA/insulin therapy.

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There are many other themes related to person-centered care that run through the new report, including guidance on the use of language physicians use when discussing care with patients (e.g., neutral, fact-based, free of prejudices); ensuring access to education and support on diabetes self-management; taking into account the local care setting and available resources, and paying particular attention to and avoiding clinical inertia

Synthesis plus instructions. In an issue of ADA Meeting News from the 82nd Scientific Meetings in June, Robert Gabbay, MD, PhD, ADA’s Chief Scientific and Medical Officer, promised that the update would “contain even more practical implementation information than we have in previous updates were included. The whole collaborative effort is not just to synthesize the evidence for clinicians, but also to give them the tools to translate this into their practice and improve the lives of those living with diabetes.”

In today’s announcement he adds: “The comprehensive report has several new features. It not only talks about what needs to be done, but also includes a section on how to implement those changes.”

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Gabbay refers in part to a new section following each titled set of recommendations Clinical tips for cliniciansessentially a bulleted list to guide next steps.

Contributing to the accessibility of the document’s recommendations are 6 full-page color charts summarizing specific aspects of care and T2D management, providing at-a-glance profiles of all current classes of hypoglycemic agents, optimal approaches for holistic person-centred T2D management, and recommendations for initiating a insulin therapy.

The update was prepared by an international expert committee that included John B. Buse, MD, PhD, (University of North Carolina School of Medicine, Chapel Hill, NC); Melanie J Davies, CBE, MBChB, MD (Leicester Diabetes Centre, Leicester, UK); and their colleagues.

It updates the previous consensus reports from 2018 and 2019 and, like its predecessors, is published jointly in the ADA journal Diabetes Care and the EASD journal Diabetologia.

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