Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes
- Silvio E. Inzucchi1⇑,
- Richard M. Bergenstal2,
- John B. Buse3,
- Michaela Diamant4,
- Ele Ferrannini5,
- Michael Nauck6,
- Anne L. Peters7,
- Apostolos Tsapas8,
- Richard Wender9,10 and
- David R. Matthews11,12,13
- 1Section of Endocrinology, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT
- 2International Diabetes Center at Park Nicollet, Minneapolis, MN
- 3Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC
- 4Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
- 5Department of Medicine, University of Pisa School of Medicine, Pisa, Italy
- 6Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany
- 7Division of Endocrinology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
- 8Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
- 9American Cancer Society, Atlanta, GA
- 10Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA
- 11Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, U.K.
- 12National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, U.K.
- 13Harris Manchester College, University of Oxford, Oxford, U.K.
- Corresponding author: Silvio E. Inzucchi, silvio.inzucchi{at}yale.edu.
In 2012, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a position statement on the management of hyperglycemia in patients with type 2 diabetes (1,2). This was needed because of an increasing array of antihyperglycemic drugs and growing uncertainty regarding their proper selection and sequence. Because of a paucity of comparative effectiveness research on long-term treatment outcomes with many of these medications, the 2012 publication was less prescriptive than prior consensus reports. We previously described the need to individualize both treatment targets and treatment strategies, with an emphasis on patient-centered care and shared decision making, and this continues to be our position, although there are now more head-to-head trials that show slight variance between agents with regard to glucose-lowering effects. Nevertheless, these differences are often small and would be unlikely to reflect any definite differential effect in an individual patient.
The ADA and EASD have requested an update to the position statement incorporating new data from recent clinical trials. Between June and September of 2014, the Writing Group reconvened, including one face-to-face meeting, to discuss the changes. An entirely new statement was felt to be unnecessary. Instead, the group focused on those areas where revisions were suggested by a changing evidence base. This briefer article should therefore be read as an addendum to the previous full account (1,2).
Glycemic Targets
Glucose control remains a major focus in the management of patients with type 2 diabetes. However, this should always be in the context of a comprehensive cardiovascular risk factor reduction program, to include smoking cessation and the adoption of other healthy lifestyle habits, blood pressure control, lipid management with priority to statin medications, and, in some circumstances, antiplatelet therapy. Studies have conclusively determined that reducing hyperglycemia decreases the onset and progression of …