Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
Open accessAbstract
The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodium-glucose cotransporter-2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication.
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GLP-1 RA decelerate gastric emptying, curb postmeal glycemic increments, and reduce appetite, energy intake, and body weight.
“GLP-1 RA augment glucosedependent insulin secretion and glucagon suppression, decelerate gastric emptying, curb postmeal glycemic increments, and reduce appetite, energy intake, and body weight (5,6,164).”
From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [5]
The GLP-1 receptor agonists section reports improved satiety, weight loss and postprandial effects. Table 2 in the Consensus recommendation section lists slower gastric emptying for shorter-acting GLP-1 receptor agonists, but not for the longer-acting group. The copy does not explicitly say that GLP-1 receptor agonists reduce energy intake; page numbers were not available in the indexed passages. (LLM, conf=0.85)
Experimental — accuracy not yet measuredSulfonylureas are associated with an increased risk for hypoglycemia due to their glucose-independent stimulation of insulin secretion.
“However, due to their glucose-independent stimulation of insulin secretion, they are associated with an increased risk for hypoglycemia.”
From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [5]
The Sulfonylureas discussion (indexed under “DPP-4 inhibitors”; page unavailable) says sulfonylureas stimulate insulin secretion and are associated with hypoglycaemia. “Choice of glucose-lowering medication after metformin” also identifies an increased hypoglycaemia risk. The copy does not say that their insulin secretion is glucose-independent or explicitly attribute the risk to that mechanism. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe efficacy and safety of insulin are largely dependent on the education and support provided to facilitate self-management.
“However, its ef fi cacy and safety are largely dependent on the education and support provided to facilitate self-management (5,6).”
From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [5]
The DSMES section (page unavailable) says education and support enable day-to-day self-management and improve glycaemic control. The Beyond basal insulin section (page unavailable) says insulin-focused education is particularly helpful when intensifying therapy. Neither passage establishes that insulin’s efficacy and safety are largely dependent on that support. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA net energy deficit that can be maintained is important for weight loss.
“A net energy de fi cit that can be maintained is important for weight loss (5,6,22,72 -74).”
A wide range of physical activities, including leisure time activities, can significantly reduce HbA1c levels.
“A wide range of physical activities, including leisure time activities, can signi fi cantly reduce HbA1c levels (5,22,121,122).”
Metformin has traditionally been recommended as first-line glucose-lowering therapy for the management of type 2 diabetes.
“metformin has traditionally been recommended as fi rst-line glucoselowering therapy for the management of type 2 diabetes.”
GLP-1 RA augment glucose-dependent insulin secretion and glucagon suppression.
“GLP-1 RA augment glucosedependent insulin secretion and glucagon suppression, decelerate gastric emptying, curb postmeal glycemic increments, and reduce appetite, energy intake, and body weight (5,6,164).”
SGLT2i have intermediate-to-high glycemic efficacy, with lower glycemic efficacy at lower estimated glomerular filtration rate.
“They have intermediate-to-high glycemic ef fi cacy, with lower glycemic ef fi cacy at lower estimated glomerular fi ltration rate (eGFR).”
SGLT2i reduce plasma glucose by enhancing urinary excretion of glucose.
“The SGLT2i are oral medications that reduce plasma glucose by enhancing urinary excretion of glucose.”
Metformin has high efficacy in lowering HbA1c, minimal hypoglycemia risk when used as monotherapy, weight neutrality with the potential for modest weight loss, a good safety profile, and low cost.
“Because of its high ef fi cacy in lowering HbA1c, minimal hypoglycemia risk when used as monotherapy, weight neutrality with the potential for modest weight loss, good safety pro fi le, and low cost, metformin has traditionally been recommended as fi rst-line glucoselowering therapy for the management of type 2 diabetes.”
The primary advantage of insulin therapy is that it lowers glucose in a dose-dependent manner and thus can address almost any level of blood glucose.
“The primary advantage of insulin therapy is that it lowers glucose in a dose-dependent manner and thus can address almost any level of blood glucose.”
Challenges of insulin therapy include weight gain, the need for education and titration for optimal efficacy, risk of hypoglycemia, the need for regular glucose monitoring, and cost.
“Challenges of insulin therapy include weight gain, the need for education and titration for optimal ef fi cacy, risk of hypoglycemia, the need for regular glucose monitoring, and cost.”
Thiazolidinediones increase insulin sensitivity and are of high glucose-lowering efficacy.
“Thiazolidinediones (TZDs) are oral medications that increase insulin sensitivity and are of high glucose-lowering ef fi cacy (5,6).”
Sulfonylureas have high glucose-lowering efficacy but a lack of durable effect, and are inexpensive and accessible.
“As per the previous consensus report and update, sulfonylureas are assessed as having high glucoselowering ef fi cacy, but with a lack of durable effect, and the advantages of being inexpensive and accessible (5,6).”
Longer-acting basal insulin analogs have a lower risk of hypoglycemia than earlier generations of basal insulin.
“Longer-acting basal insulin analogs have a lower risk of hypoglycemia than earlier generations of basal insulin, although they may cost more.”
Current guidelines in the USA and UK stress the importance of structured and individualised education and European Association for the Study of Diabetes/American Diabetes Association guidelines state the importance of shared decision-making.
“Current guidelines in the USA and UK stress the importance of structured and individualised education [21, 22] and European Association for the Study of Diabetes/American Diabetes Association guidelines state the importance of shared decision-making [8, 23].”
Lack of adherence and persistence with treatment in T2DM increases healthcare costs.
“Lack of adherence and persistence with treatment in T2DM acts as a barrier to achieving glycaemic control [6], increases the risk of microvascular and macrovascular complications [7], and increases healthcare costs [5, 8].”
Patient-HCP discussions before treatment initiation may help people with T2DM to better understand their options and allow for individualisation of therapy, as recommended by the American Diabetes Association/European Association for the Study of Diabetes guidelines.
“Patient–HCP discussions before treatment initiation may help people with T2DM to better understand their options and allow for individualisation of therapy, as recommended by the American Diabetes Association/European Association for the Study of Diabetes guidelines [8, 23].”
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- Authors
- Davies, M. J., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., Rossing, P., Tsapas, A., Wexler, D. J., & Buse, J. B.
- Affiliations
- University of Leicester (GB)
- Duke University (US)
- National Institutes of Health (US)
- Yale University (US)
- Universitair Ziekenhuis Leuven (BE)
- King's College London (GB)
- University of Copenhagen (DK)
- Harvard University (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Davies, Melanie J.
- ORCID
- Venue
- Diabetologia
- Published
- 2018-10-05
- Volume
- 61
- Issue
- 12
- Pages
- 2461-2498
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2895533920
- Cited by
- 1,455
- References
- 269
- Citations by year
- 2026: 22 · 2025: 54 · 2024: 78 · 2023: 127 · 2022: 195 · 2021: 297 · 2020: 420 · 2019: 235 · 2018: 23 · 2017: 1
- FWCI
- 192.73
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-03-21)
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (acceptedVersion, cc-by)
- Lirias (submittedVersion, other-oa)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- U.S. Department of Health and Human Services (UL1TR002489)
- American Diabetes Association
- Bristol-Myers Squibb
- Eli Lilly and Company
- AstraZeneca
- Sanofi
- Massachusetts General Hospital
- Yale University
- Gilead Sciences
- University of Pennsylvania
- Emory University
- Washington State University
- University of Washington
- Tulane University
- Universitat de Girona
- National University of Ireland
- Intarcia Therapeutics
- MannKind Corporation
- Steno Diabetes Center Copenhagen (SDCC 3.A Complications)
- University of Leicester
- University of Southampton
- University of Oxford
- Newcastle University
- University of Galway
- European Foundation for the Study of Diabetes
- Novo Nordisk
- Universitetet i Oslo
- Università di Pisa
- European Association for the Study of Diabetes
- Servier
- Mitsubishi Tanabe Pharma Corporation
- National Institutes of Health (UL1TR002489)
- Takeda Pharmaceuticals International
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, hyperglycemia management, lifestyle management, diabetes self-management education and support, obesity, weight loss, bariatric surgery, SGLT2 inhibitors, GLP-1 receptor agonists, cardiovascular disease, chronic kidney disease, heart failure, atherosclerotic cardiovascular disease, antidiabetic drugs
- MeSH terms
- Liraglutide, Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Europe, Heart Failure, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, United States, Renal Insufficiency, Chronic
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