Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Davies, Melanie J.; Aroda, Vanita R.; Collins, Billy S.; Gabbay, Robert A.; Green, Jennifer; Maruthur, Nisa M.; Rosas, Sylvia E.; Del Prato, Stefano; Mathieu, Chantal; Mingrone, Geltrude; Rossing, Peter; Tankova, Tsvetalina; Tsapas, Apostolos; Buse, John B.

doi:10.1007/s00125-022-05787-2

Cited by 1,048Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

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Davies, Melanie J., Aroda, Vanita R., Collins, Billy S., Gabbay, Robert A., Green, Jennifer, Maruthur, Nisa M., Rosas, Sylvia E., Del Prato, Stefano +6 more·2022·Diabetologia

DOI 10.1007/s00125-022-05787-2PMC PMC9510507

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Abstract

The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the previous consensus statements on the management of hyperglycaemia in type 2 diabetes in adults, published since 2006 and last updated in 2019. The target audience is the full spectrum of the professional healthcare team providing diabetes care in the USA and Europe. A systematic examination of publications since 2018 informed new recommendations. These include additional focus on social determinants of health, the healthcare system and physical activity behaviours including sleep. There is a greater emphasis on weight management as part of the holistic approach to diabetes management. The results of cardiovascular and kidney outcomes trials involving sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, including assessment of subgroups, inform broader recommendations for cardiorenal protection in people with diabetes at high risk of cardiorenal disease. After a summary listing of consensus recommendations, practical tips for implementation are provided.

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A weight loss of at least 5% can delay the onset of T2DM and reduce the occurrence of cardiovascular diseases.
“A weight loss of at least 5% can delay the onset of T2DM and reduce the occurrence of cardiovascular diseases”
From New Developments in Pharmacological Treatment of Obesity and Type 2 Diabetes—Beyond and within GLP-1 Receptor Agonists (2024) · cites this paper as [3]
The weight-management section (page unavailable) says that at least 5% weight loss can have clinical benefits in people who already have type 2 diabetes; it does not say this delays the onset of diabetes. The Nutrition therapy section (page unavailable) reports no difference in the primary cardiovascular outcome in the Look AHEAD trial and suggests that at least 10% weight loss may be needed for benefits in cardiovascular events. Thus, the paper supports benefits of weight loss, but not the two outcomes claimed at the stated threshold. (LLM, conf=0.88)
Experimental — accuracy not yet measured
SGLT2 inhibitors are now co-first line with metformin in the treatment algorithm for people at high cardiovascular risk or with existing atherosclerotic disease, heart failure or chronic kidney disease.
“Sodium‐glucose cotransporter‐2 inhibitors have been used in the management of diabetes mellitus for several years, but with the additional cardiovascular benefits they are now co‐first line with metformin in the treatment algorithm for people at high cardiovascular risk or with existing atherosclerotic disease, heart failure or chronic kidney disease [84, 85, 86].”
From Elective peri‐operative management of adults taking glucagon‐like peptide‐1 receptor agonists, glucose‐dependent insulinotropic peptide agonists and sodium‐glucose cotransporter‐2 inhibitors: a multidisciplinary consensus statement: A consensus statement from the Association of Anaesthetists, Association of British Clinical Diabetologists, British Obesity and Metabolic Surgery Society, Centre for Perioperative Care, Joint British Diabetes Societies for Inpatient Care, Royal College of Anaesthetists, Society for Obesity and Bariatric Anaesthesia and UK Clinical Pharmacy Association (2025) · cites this paper as [84]
The Metformin subsection (page unavailable) says SGLT2 inhibitors should be considered for people with established or high cardiovascular risk, heart failure, or chronic kidney disease, independently of metformin use; it also allows combination therapy at treatment initiation. The report does not designate SGLT2 inhibitors as categorically “co-first line with metformin”: it also recommends GLP-1 receptor agonists for some of these indications and describes metformin as traditionally first-line. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Contemporary ADA-EASD and ESC guidelines strongly recommend early initiation of GLP-1RAs or SGLT-2is in patients with established or high risk of CVD.
“Contemporary ADA‐EASD and European Society of Cardiology (ESC) guidelines strongly recommend early initiation of GLP‐1RAs or SGLT‐2is in patients with established or high risk of CVD. 4 , 5 , 35”
From Real‐world persistence and dose titration of <scp>GLP</scp> ‐1 receptor agonists in type 2 diabetes: A <scp>UK</scp> population‐based cohort study by obesity and cardiovascular disease status (2026) · cites this paper as [5]
The Consensus recommendations strongly support GLP-1 RA or SGLT2i use in people with established CVD, and say the decision should be independent of baseline HbA1c and metformin use. For people without established CVD but with multiple risk factors, however, they say these agents “could be used”; the Choice of glucose-lowering medication section says their introduction “can be considered” and notes less robust evidence. Thus the claim overstates the strength of the recommendation for the high-risk group. The cited paper is an ADA–EASD report, so it does not itself establish what ESC guidelines recommend. (LLM, conf=0.89)
Experimental — accuracy not yet measured
The ADA Standards of Care and the ADA/EASD consensus report recommend subcutaneously administered semaglutide and tirzepatide as the most efficacious medications for glycaemic control (alongside dulaglutide) and weight reduction.
“The ADA Standards of Care and the ADA/EASD consensus report recommend s.c. administered semaglutide and tirzepatide as the most efficacious medications for glycaemic control (alongside dulaglutide) and weight reduction [4, 5].”
From Subcutaneously administered tirzepatide vs semaglutide for adults with type 2 diabetes: a systematic review and network meta-analysis of randomised controlled trials (2024) · cites this paper as [4]
The ‘Medications for lowering glucose’ section reports strong glycaemic and weight-loss effects for subcutaneous semaglutide and tirzepatide, and improved glycaemic control with higher-dose dulaglutide. But its comparative-efficacy discussion also identifies insulin regimens among those producing the greatest HbA1c reductions; it does not recommend the named drugs as a definitive group of the most efficacious for both outcomes. The ‘Weight management beyond lifestyle interventions’ section further notes that tirzepatide was not yet approved for weight management (page numbers unavailable in our copy). (LLM, conf=0.85)
Experimental — accuracy not yet measured
Medication options are already available to treat obesity and can help reduce appetite and/or caloric intake.
“Medication options are already available to treat obesity, which can help reduce appetite and/or reduce caloric intake.”
From New Developments in Pharmacological Treatment of Obesity and Type 2 Diabetes—Beyond and within GLP-1 Receptor Agonists (2024) · cites this paper as [3]

Long-term sustained weight loss of 10-15% can induce T2DM remission and provide numerous other health benefits.
“long-term sustained weight loss of 10–15% can even induce T2DM remission and provide numerous other health benefits [3,4].”
From New Developments in Pharmacological Treatment of Obesity and Type 2 Diabetes—Beyond and within GLP-1 Receptor Agonists (2024) · cites this paper as [3]
The study's findings stand in stark contrast with current ADA-EASD and ESC guidelines, which advocate for GLP-1RAs to reduce cardiovascular risk.
“This finding stands in stark contrast with current ADA‐EASD and ESC guidelines, which advocate for GLP‐1RAs to reduce cardiovascular risk. 4 , 5 , 35”
From Real‐world persistence and dose titration of <scp>GLP</scp> ‐1 receptor agonists in type 2 diabetes: A <scp>UK</scp> population‐based cohort study by obesity and cardiovascular disease status (2026) · cites this paper as [5]
Clinical practice recommendations by the ADA Standards of Care and the ADA/EASD consensus report place s.c. tirzepatide and s.c. semaglutide among the most efficacious treatment for lowering glucose (alongside dulaglutide) and reducing weight in people with type 2 diabetes.
“Clinical practice recommendations by the ADA Standards of Care and the ADA/EASD consensus report place s.c. tirzepatide and s.c. semaglutide among the most efficacious treatment for lowering glucose (alongside dulaglutide) and reducing weight in people with type 2 diabetes [4, 5]”
From Subcutaneously administered tirzepatide vs semaglutide for adults with type 2 diabetes: a systematic review and network meta-analysis of randomised controlled trials (2024) · cites this paper as [4]
A sustained 5% reduction in body weight can reduce the onset and severity of type 2 diabetes and cardio-renal diseases, while long-term weight reductions of 10-15% can often facilitate remission of type 2 diabetes and deliver additional health benefits.
“a sustained 5% reduction in body weight can reduce the onset and severity of T2DM and cardio-renal diseases, while long-term weight reductions of 10-15% can often facilitate remission of T2DM and deliver a spectrum of additional health benefits [4,5].”
From Recent advances in peptide-based therapies for obesity and type 2 diabetes (2024) · cites this paper as [5]
Unlike insulin and secretagogues, oral agents such as metformin, SGLT-2 inhibitors, DPP4 inhibitors, and GLP-1 agonists do not pose the same hypoglycemia risk and may be continued.
“Other oral medications, which have become the gold standard of treatment for T2DM, such as metformin, sodiumglucose co-transporter 2 (SGLT-2) inhibitors, dipeptidyl-peptidase 4 (DPP4) inhibitors, and glucagon-like peptide 1 (GLP-1) agonists do not have the same risk of hypoglycemia and can be continued.26”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [26]
Using insulin or insulin secretagogues like sulfonylureas before exercise can cause blood sugar to fall further.
“Taking these medications prior to exercise can lead to further decline in blood sugar.24,26”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [26]
Oral agents including metformin, SGLT-2 inhibitors, DPP4 inhibitors, and GLP-1 agonists are now standard treatments for T2DM.
“Other oral medications, which have become the gold standard of treatment for T2DM, such as metformin, sodiumglucose co-transporter 2 (SGLT-2) inhibitors, dipeptidyl-peptidase 4 (DPP4) inhibitors, and glucagon-like peptide 1 (GLP-1) agonists do not have the same risk of hypoglycemia and can be continued.26”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [26]

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Historical HbA1c values may explain the type 2 diabetes legacy effect: UKPDS 88
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Susquehanna Chorale Spring Concert "Roots and Wings"
Hawkins, D. (2017)
ИСПОЛЬЗОВAНИЕ ПОТЕНЦИAЛA СОЦИAЛЬНЫХ ПAРТНЕРОВ В ПОДГОТОВКЕ БУДУЩИХ ПЕДAГОГОВ
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Authors: Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., Rosas, S. E., Del Prato, S., Mathieu, C., Mingrone, G., Rossing, P., Tankova, T., Tsapas, A., & Buse, J. B.
Affiliations: University of Leicester (GB)
Brigham and Women's Hospital (US)
National Heart, Lung, and Blood Institute (US)
Duke University (US)
Johns Hopkins University (US)
Joslin Diabetes Center (US)
KU Leuven (BE)
Università Cattolica del Sacro Cuore (IT)
University of Copenhagen (DK)
Medical University of Sofia (BG)
University of North Carolina at Chapel Hill (US)
Corresponding author: Davies, Melanie J.
Buse, John B.
ORCID: Davies, Melanie J.
Aroda, Vanita R.
Collins, Billy S.
Gabbay, Robert A.
Green, Jennifer
Maruthur, Nisa M.
Rosas, Sylvia E.
Del Prato, Stefano
Mathieu, Chantal
Mingrone, Geltrude
Rossing, Peter
Tankova, Tsvetalina
Tsapas, Apostolos
Buse, John B.
Venue: Diabetologia
Publisher: Springer Science and Business Media LLC
Published: 2022-09-24
Volume: 65
Issue: 12
Pages: 1925-1966
ISSN: 0012-186X (ISSN-L)
1432-0428
DOI: 10.1007/s00125-022-05787-2
PMC: PMC9510507
OpenAlex: W4297021616
Cited by: 1,048
References: 335
Citations by year: 2026: 198 · 2025: 223 · 2024: 291 · 2023: 274 · 2022: 34 · 2021: 6 · 2020: 7 · 2019: 14 · 2018: 1
FWCI: 152.20
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Diabetologia (publishedVersion)
PubMed Central (publishedVersion)
Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
PubMed (publishedVersion)
Figshare (submittedVersion, cc-by)
Research Portal (King's College London) (submittedVersion)
Lirias (KU Leuven) (submittedVersion)
Funders: American Diabetes Association
Eli Lilly and Company
Pfizer
AstraZeneca
Sanofi
Gilead Sciences
Ohio State University
Medpace
Johns Hopkins University
University Hospitals of Leicester NHS Trust
Insulet Corporation
ReCor Medical
Dexcom
Moderna
University of Leicester
University of Southampton
Newcastle University
European Foundation for the Study of Diabetes
Daewoo Shipbuilding & Marine Engineering
KU Leuven
Novo Nordisk
Sapienza Università di Roma
Astellas Pharma
Universitat de Barcelona
Aristotle University of Thessaloniki
European Association for the Study of Diabetes
Servier
University of North Carolina at Chapel Hill
Takeda Pharmaceuticals International
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK124723)
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, glycemic control, social determinants of health, physical activity, sleep, weight management, SGLT2 inhibitors, GLP-1 receptor agonists, cardiorenal protection, cardiovascular outcomes, renal outcomes
MeSH terms: Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Adult, Diabetes Mellitus, Type 2, Humans, Hyperglycemia, Hypoglycemic Agents, United States

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Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

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