The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have published new guidelines on the treatment of type 2 diabetes, which are less prescriptive than previous guidelines. They advocate more patient involvement and give guidance on the rational approach to the choice of therapy.
While general recommendations regarding the intensiveness of glycaemic therapy focused in the past on a HbA1c target below 7%, the new statement emphasises that goals must be individualised, with the precise target taking into account patient’s attitude and expected treatment efforts, the risk associated with glycaemia and other adverse effects, disease duration, life expectancy, other co-morbidities, established vascular complications, and the patient’s own resources and support system.
It notes, for example, some patients may feel that the weight gain associated with a particular diabetes therapy is unacceptable, whereas others may consider risk of hypoglycaemia as the primary factor in selecting treatment. And patients who are older with multiple co-morbidities will have different issues compared with a younger newly-diagnosed person that is otherwise healthy.
EASD president, Professor Andrew Boulton (University of Manchester) said: “The overarching goal should be to reduce blood glucose concentrations safely to a range that will substantially minimise long-term complications, but always keeping in mind the potential adversities with treatment burden, particularly in the elderly”.
Other key points from the guidelines include:
- Diet, exercise and education to remain the foundation of any type 2 diabetes treatment programme
- Unless there are prevalent contraindications, metformin is the optimal first-line drug
- After metformin, there are limited data to guide treatment. Combination therapy with an additional one or two oral or injectable agents is reasonable, aiming to minimise side effects where possible
- Ultimately, many patients will require insulin therapy alone or in combination with other agents to maintain glucose control.