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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 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]
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In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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“A net energy de fi cit that can be maintained is important for weight loss (5,6,22,72 -74).”
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“A wide range of physical activities, including leisure time activities, can signi fi cantly reduce HbA1c levels (5,22,121,122).”
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“metformin has traditionally been recommended as fi rst-line glucoselowering therapy for the management of type 2 diabetes.”
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“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).”
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“They have intermediate-to-high glycemic ef fi cacy, with lower glycemic ef fi cacy at lower estimated glomerular fi ltration rate (eGFR).”
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“The SGLT2i are oral medications that reduce plasma glucose by enhancing urinary excretion of glucose.”
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“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.”
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“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.”
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“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.”
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“Thiazolidinediones (TZDs) are oral medications that increase insulin sensitivity and are of high glucose-lowering ef fi cacy (5,6).”
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“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).”
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“Longer-acting basal insulin analogs have a lower risk of hypoglycemia than earlier generations of basal insulin, although they may cost more.”
In the citing paper
“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].”
In the citing paper
“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].”
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“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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Citations
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2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
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Self-citationGLP-1 receptor agonists in the treatment of type 2 diabetes - state-of-the-art
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“Most other glucose-lowering agents, except for sodium/glucose cotransporter-2 (SGLT-2) inhibitors, usually lead to some weight gain (sulfonylureas, insulin, or thiazolidinediones) or are weight neutral (metformin, DPP-4 inhibitors, or a-glucosidase inhibitors) [47].”
KDIGO 2020 Clinical practice guideline for diabetes management in chronic kidney disease
de Boer, I. H., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., et al. (2020) · Kidney International · doi:10.1016/j.kint.2020.06.019 · Cited by 1,399
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Metadata
- 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
- 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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