PracticeUpdate Diabetes Best of 2018

EASD 2018 25

Consensus Guidelines for Managing Hyperglycemia in Type 2 Diabetes Released by American and European Diabetes Associations

Focus is on patient-centered glycemic management T he European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have released joint guidelines on how to manage hyperglycemia in patients with type 2 diabetes. This consensus report was presented at EASD 2018. It is being simultaneously co-published in the EASD journal Diabetologia and the ADA journal Diabetes Care .

• Use of GLP-1 receptor agonists as the first injectable instead of insulin Importantly, the consensus report encourages clinicians to con- centrate on patient-centered management. This is outlined in the first figure to appear in the report, called “The Decision Cycle”. Dr. Cefalu noted that this includes the need to do the following: • Assess key patient characteristics, which includes assessment of current lifestyles; comorbidities such as atherosclerotic car- diovascular disease, chronic kidney disease, and heart failure; clinical characteristics such as HbA1c, age, weight, motivation, and depression; and cultural and socioeconomic context. • Consider specific factors that impact treatment choice. • Engage in shared decision-making with patients to create, agree on, and implement a diabetes care plan. • Ensure ongoing monitoring and support with a focus on mental health, medication tolerance and adherence, monitoring of blood glucose, weight, nutrition, physical fitness and exercise, and smoking-cessation counseling and support. • Engage in continuous collaboration, including review and agree- ment on personalized diabetes care plans. “The report revolves around patient-centered glycemic manage- ment to prevent complications and to optimize quality of life,” Dr. Cefalu said. “We hope providers will continue to practice patient-centered care that accounts for each individual’s health history and status, weight, hypoglycemic risk, and preferences. While the algorithms focus on the choice of diabetes medications, the report also highlights the critical importance of comprehensive lifestyle management and diabetes self-management education and support in the overall health of people with type 2 diabetes.” “The consensus report was incorporated into the ADA’s Standards of Medical Care in Diabetes as a living update, so we hope that providers will consult the guidance to help improve care for their patients with diabetes,” he added. www.practiceupdate.com/c/74934

The consensus report was developed fol- lowing a systematic evaluation of the literature since 2014. This included a review of 479 published manuscripts, with a particu- lar focus on key cardiovascular outcomes trials in the past four years. The goal is to provide clinicians with guidance on how to optimize blood glucose control to improve patient outcomes and reduce the serious complications of type 2 diabetes, including

Dr. William T. Cefalu

both cardiovascular and hepatic problems. The report puts particular emphasis on lifestyle management, dia- betes self-management, education, and support. For patients who are obese, efforts targeting weight loss, including lifestyle, medi- cation, and surgical interventions, are recommended. With regard to medication management, metformin remains the preferred first-line option in most patients. For those with clinical cardiovascular disease, an SGLT2 inhibitor or GLP-1 receptor ago- nist with proven cardiovascular benefit is also recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is preferred. GLP-1 receptor agonists are generally recommended as the first injectable medication, ahead of insulin. “This consensus report is critical because an incredible amount of new evidence has been released that can improve clinical care,” William T. Cefalu, MD, told Elsevier’s PracticeUpdate . “This update was informed by evidence generated in the past 2 years. This is particularly important given the new data on diabetes and cardi- ovascular disease.” Dr. Cefalu is the chief scientific and medical officer of the ADA and president of the Association’s research foundation. According to Dr. Cefalu, the key clinical issues addressed in the consensus report are: • A greater focus on lifestyle interventions, with increased emphasis on weight loss and obesity management, including metabolic surgery • Development of a personalized diabetes care plan, with increased focus on patient-related issues and self-man- agement, both of which have a major impact on the success of all other interventions, including medications • An emphasis on addressing gaps in care or accessi- bility, especially how it impacts medication adherence and persistence • Preferred choices of glucose-lowering agents based on the latest evidence frommajor cardiovascular outcomes trials and consideration of areas of major clinical need (for example, weight and risk of hypoglycemia)

© EASD 2018

VOL. 2 • NO. 4 • 2018