The European Association for the study of diabetes (EASD) guidelines for the treatment of type 2 diabetes were published in the journal Diabetologia on October 05, 2018.I already wrote about this in June 2018, but there I used slides from the conference. Now an official document has been published and attached.
I also made a chart on sugar-lowering drugs (see the picture and attached file).
This document is an update of the document from 2015.
The new paper focuses not on an individual glycemic goal, but on how to achieve this individualized glycemic goal, taking into account the patient’s factors and preferences, and taking into account the increasing choice of treatments for glycemic control.
The document now recommends a first step assessment of the patient’s cardiovascular status to determine the treatment approach. Separate algorithms recommend treatment for patients with atherosclerotic cardiovascular disease and for patients with heart failure.
Lifestyle modification and Metformin are still considered to be the basis of treatment, although there was debate over the continued role of Metformin as a first-line drug when the document was developed. In the end, we decided to leave this recommendation given the low cost of the drug, proven safety and effectiveness.
Further, for patients with a predominance of atherosclerotic cardiovascular pathology, it is recommended first of all to use a glucagon-like peptide-1 receptor agonist with proven benefit in cardiovascular pathology, if not, a sodium-glucose-cotransporter-2 inhibitor (with adequate kidney function) with proven benefit in cardiovascular pathology.
In patients with predominant heart failure, the sequence is reversed: first, we recommend the use of a sodium-glucose-cotransporter-2 inhibitor that can improve heart failure (with adequate kidney function), and the alternative is the use of a glucagon-like peptide-1 receptor agonist with proven benefits in cardiovascular diseases.
General approach: the choice of a drug to be added to Metformin should be based on the patient’s preferences and important clinical characteristics, which include the presence of established atherosclerotic cardiovascular disease, other comorbidities, and the risk of specific side effects of the drug, especially hypoglycemia and weight gain, as well as the safety, tolerability, and cost of the drug.
According to the new document, if a patient needs an injectable drug, preference is now given to the agonist of the glucagon-like peptide-1 receptor over insulin. If insulin is selected based on clinical characteristics, basal insulin is preferred.
If you start using injectable drugs, then you can see visual diagrams in the form of traffic light colors to reduce the dose or cancel oral medications.