2019 update to: 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 have briefly updated their 2018 recommendations on management of hyperglycaemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: (1) the decision to treat high-risk individuals with a glucagon-like-peptide 1 (GLP-1) receptor agonist or sodium-glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalisation for heart failure (hHF), cardiovascular death or chronic kidney disease (CKD) progression should be considered independently of baseline HbA 1c or individualised HbA 1c target; (2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and (3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE and CVD death, as well as in patients with type 2 diabetes with CKD (eGFR 30 to ≤60 ml min-1 [1.73 m]-2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE and cardiovascular death.
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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.”
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 [6]
The SGLT2 inhibitor recommendations section discusses metformin alone as an initial treatment comparator and says the authors previously saw limited evidence for initial combination therapy. This is consistent with metformin being used first, but our copy does not explicitly say it was traditionally recommended as first-line therapy. No page number is provided for the passage. (LLM, conf=0.73)
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 [6]
In the SGLT2 inhibitor recommendations section (page unavailable), the paper reports less hypoglycaemia with linagliptin than with glimepiride, a sulfonylurea. It does not attribute that difference to glucose-independent insulin secretion and explicitly says it is unclear whether the findings extend to other sulfonylureas. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSulfonylureas 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).”
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 [6]
The SGLT2 inhibitor recommendations section describes glimepiride as an inexpensive and effective sulfonylurea, supporting the cost and efficacy points for that drug. It does not say sulfonylureas as a class have high glucose-lowering efficacy, lack a durable effect, or are accessible; it cautions that the glimepiride findings may not extend to other sulfonylureas. No page number is available in our copy. (LLM, conf=0.87)
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).”
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 [6]
The SGLT2 inhibitor recommendations discuss a weight-loss difference between medications, but not an energy deficit or whether it can be maintained. Searches for “net energy deficit,” “energy deficit,” and sustainable dietary weight loss found no passage in our copy addressing the claim; page numbers were not available. (LLM, conf=0.73)
Experimental — accuracy not yet measuredMetformin 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.”
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 [6]
The SGLT2 inhibitor recommendations section discusses metformin in a trial of initial combination therapy, but does not describe metformin’s HbA1c-lowering efficacy, hypoglycaemia risk, weight effects, safety profile, or cost. Searches for those properties and for a first-line metformin recommendation found no passage addressing the claim; page numbers were unavailable in our copy. (LLM, conf=0.74)
Experimental — accuracy not yet measured
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 [6]
The GLP-1 receptor agonist recommendations (page unavailable) discuss cardiovascular outcomes, not the physiological or weight effects in the claim. Searches for gastric emptying, postmeal glucose, appetite, energy intake, and body weight found no passage in our copy addressing those effects. (LLM, conf=0.72)
Experimental — accuracy not yet measuredGLP-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).”
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 [6]
The GLP-1 receptor agonist recommendations section discusses cardiovascular outcomes, not how these drugs affect insulin or glucagon. Searches for glucose-dependent insulin secretion, glucagon suppression, and related mechanisms found no passage in our copy addressing the attributed claim; page numbers were not available. (LLM, conf=0.75)
Experimental — accuracy not yet measuredThiazolidinediones 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).”
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 [6]
The SGLT2 inhibitor recommendations discuss other glucose-lowering drug classes, and the figure captions identify an overall treatment approach, but the available text does not describe thiazolidinediones’ mechanism or rate their glucose-lowering efficacy. Searches for thiazolidinediones, TZDs, insulin sensitivity, and related terms found no passage addressing the claim; page numbers were not available. (LLM, conf=0.74)
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 [6]
The General consideration section (page unavailable) discusses shared decision-making about initial combination therapy, not education or support for insulin self-management. Searches for insulin, education, self-management, and hypoglycaemia found no passage in our copy addressing whether insulin’s efficacy and safety depend on that support. (LLM, conf=0.73)
Experimental — accuracy not yet measuredThe 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.”
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 [6]
The General consideration and SGLT2 inhibitor recommendations passages discuss GLP-1 receptor agonists and SGLT2 inhibitors, not insulin’s dose-dependent glucose-lowering effect. Searches for insulin, dose-dependent lowering, and the ability to address almost any blood-glucose level found no passage in our copy addressing the claim; no page numbers were provided. (LLM, conf=0.72)
Experimental — accuracy not yet measuredChallenges 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.”
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 [6]
The SGLT2 inhibitor recommendations discuss cost for GLP-1 receptor agonists and SGLT2 inhibitors, and weight and hypoglycaemia in a comparison of linagliptin with glimepiride—not challenges of insulin therapy. Searches for insulin, titration, education and glucose monitoring found no passage in this update addressing the attributed list. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Self-citation
- Authors
- Buse, J. B., Wexler, D. J., Tsapas, A., Rossing, P., Mingrone, G., Mathieu, C., D’Alessio, D. A., & Davies, M. J.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Harvard University (US)
- University of Copenhagen (DK)
- Università Cattolica del Sacro Cuore (IT)
- Universitair Ziekenhuis Leuven (BE)
- Duke University (US)
- University of Leicester (GB)
- Corresponding author
- Davies, Melanie J.
- ORCID
- Venue
- Diabetologia
- Published
- 2019-12-19
- Volume
- 63
- Issue
- 2
- Pages
- 221-228
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W4237332786
- Cited by
- 487
- References
- 20
- Citations by year
- 2026: 6 · 2025: 24 · 2024: 42 · 2023: 68 · 2022: 101 · 2021: 128 · 2020: 118
- FWCI
- 70.60
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-05-15)
- Open access
- bronze
- doi.org
- Locations
- Diabetologia (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Lirias (KU Leuven) (submittedVersion)
- UNC Libraries
- Funders
- American Diabetes Association
- Eli Lilly and Company
- AstraZeneca
- Sanofi
- Gilead Sciences
- CSL Behring
- Intarcia Therapeutics
- MannKind Corporation
- Steno Diabetes Center Copenhagen (SDCC 3.A Complications)
- European Foundation for the Study of Diabetes
- Novo Nordisk
- European Association for the Study of Diabetes
- Servier
- Mitsubishi Tanabe Pharma Corporation
- National Institutes of Health (UL1TR002489)
- Takeda Pharmaceuticals International
- National Institute of Diabetes and Digestive and Kidney Diseases
- Division of Diabetes, Endocrinology, and Metabolic Diseases
- 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 › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- hyperglycemia management, type 2 diabetes, GLP-1 receptor agonists, SGLT2 inhibitors, major adverse cardiovascular events, heart failure hospitalization, heart failure with reduced ejection fraction, chronic kidney disease progression, HbA1c targets, cardiovascular risk stratification
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Europe, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Societies, Medical, United States
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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