Lifestyle changes, the drug metformin remain recommended initial therapy
A stepped-up care approach is outlined in updated treatment recommendations for type 2 diabetes released Wednesday by the American Diabetes Association and the European Association for the Study of Diabetes.Lifestyle changes and the drug metformin remain the recommended initial treatment to help people newly diagnosed with type 2 diabetes control levels of blood glucose and A1C, a measure of average glucose levels during the previous two to three months, according to the panel of experts who wrote the updated guidelines.
If this fails to help patients achieve target glucose/A1C levels, there are two treatment choices. One -- which is preferred and well-validated -- involves the addition of basal insulin or a sulfonylurea to lifestyle changes and metformin. The second choice involves the addition of the drug pioglitazone or a GLP-1 agonist to lifestyle changes and metformin.
If neither of the step 2 choices work, the experts suggested the use of basal insulin, if not already started, and then transition to intensive insulin, if needed.
As in the original guidelines, all of the transitions in therapy usually occur at three-month intervals, with the objective of achieving rapid and continuous maintenance of near-normal glucose and A1C levels.
The updated guidelines were published online in the journals Diabetes Care and Diabetologia.
"Excellent glycemic control is critical to prevent the long-term complications associated with diabetes, which can lead to loss of vision, kidney failure, and amputation," Dr. David M. Nathan, panel chairman, said in an American Diabetes Association news release.
"After much deliberation, we intentionally chose therapies we highly recommend as safe, effective, and that have much evidence supporting their use. The second tier drugs are valuable if hypoglycemia [low blood sugar] is a major concern, but the use of these drugs is less validated," he said.
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