2019 update to: management of hyperglycemia 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 hyperglycemia, 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), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c 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 (estimated glomerular filtration rate 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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Numerous rigorous clinical trials demonstrated large kidney and cardiovascular benefits of SGLT2i, and SGLT2i became an established first-line treatment for T2D with CKD.
“During the time between initiation and completion of the FIDELIO-DKD and FIGARO-DKD trials, numerous rigorous clinical trials demonstrated large kidney and cardiovascular bene fi ts of SGLT2i (Section 1.3 above), and SGLT2i became an established fi rst-line treatment for T2D with CKD.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [143]
The Abstract reports renal and cardiovascular benefits from SGLT2-inhibitor trials and recommends SGLT2 inhibitors for people with type 2 diabetes and CKD. It does not call them a first-line treatment, and it says the benefits are less well established for lesser grades of CKD. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe prioritization of SGLT2i therapy in high-risk patients such as those with CKD is consistent with the recommendations from other professional societies including the American College of Cardiology (ACC), the joint statement by the ADA and the European Association of the Study of Diabetes (EASD), and the joint guideline by the European Society of Cardiology (ESC) and EASD.
“The prioritization of SGLT2i therapy in high-risk patients such as those with CKD is consistent with the recommendations from other professional societies including the American College of Cardiology (ACC), 142 the joint statement by the ADA and the European Association of the Study of Diabetes (EASD), 143 and the joint guideline by the European Society of Cardiology (ESC) and EASD.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [143]
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- [11]Mahaffey KW, Jardine MJ, Bompoint S, Canagliflozin and cardiovascular and renal outcomes in type 2 diabetes mellitus and chronic kidney disease in primary and secondary cardiovascular prevention groups. Circulation 2019; 140: 739– 750 31291786 PMC6727954
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Diabetes: From Research to Clinical Practice
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- 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)
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
- 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
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2019-12-19
- Volume
- 43
- Issue
- 2
- Pages
- 487-493
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC6971782
- OpenAlex
- W4253996779
- Cited by
- 1,192
- References
- 21
- Citations by year
- 2026: 54 · 2025: 79 · 2024: 128 · 2023: 162 · 2022: 277 · 2021: 279 · 2020: 212
- FWCI
- 155.76
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-07-01)
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- Lirias (submittedVersion)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, other-oa)
- Funders
- American Diabetes Association
- European Association for the Study of Diabetes
- 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
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