Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach
Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
- Silvio E. Inzucchi, MD1,
- Richard M. Bergenstal, MD2,
- John B. Buse, MD, PHD3,
- Michaela Diamant, MD, PHD4,
- Ele Ferrannini, MD5,
- Michael Nauck, MD6,
- Anne L. Peters, MD7,
- Apostolos Tsapas, MD, PHD8,
- Richard Wender, MD9 and
- David R. Matthews, MD, DPHIL10,11,12
- From the 1Section of Endocrinology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut; the
- 2International Diabetes Center at Park Nicollet, Minneapolis, Minnesota; the
- 3Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; the
- 4Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands; the
- 5Department of Medicine, University of Pisa School of Medicine, Pisa, Italy;
- 6Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany; the
- 7Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California; the
- 8Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece; the
- 9Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; the
- 10Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, U.K.; the
- 11National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, U.K.; and the
- 12Harris Manchester College, University of Oxford, Oxford, U.K
- Corresponding author: Silvio E. Inzucchi, silvio.inzucchi{at}yale.edu.
S.E. Inzucchi and D.R. Matthews were co-chairs for the Position Statement Writing Group. R.M. Bergenstal, J.B. Buse, A.L. Peters, and R. Wender were the Writing Group for the ADA. M. Diamant, E. Ferrannini, M. Nauck, and A. Tsapas were the Writing Group for the EASD.
Glycemic management in type 2 diabetes mellitus has become increasingly complex and, to some extent, controversial, with a widening array of pharmacological agents now available (1–5), mounting concerns about their potential adverse effects and new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications (6–9). Many clinicians are therefore perplexed as to the optimal strategies for their patients. As a consequence, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a joint task force to examine the evidence and develop recommendations for antihyperglycemic therapy in nonpregnant adults with type 2 diabetes. Several guideline documents have been developed by members of these two organizations (10) and by other societies and federations (2,11–15). However, an update was deemed necessary because of contemporary information on the benefits/risks of glycemic control, recent evidence concerning efficacy and safety of several new drug classes (16,17), the withdrawal/restriction of others, and increasing calls for a move toward more patient-centered care (18,19).
This statement has been written incorporating the best available evidence and, where solid support does not exist, using the experience and insight of the writing group, incorporating an extensive review by additional experts (acknowledged below). The document refers to glycemic control; yet this clearly needs to be pursued within a multifactorial risk reduction framework. This stems from the fact that patients with type 2 diabetes are at increased risk of cardiovascular morbidity and mortality; the aggressive management of cardiovascular …
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