Tailoring Type 2 Diabetes Treatment: Updated Guidance

Today I am going to discuss the 2015 update to the position statement on the treatment of hyperglycemia in patients with type 2 diabetes.^[1]

This is a joint position statement by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). I actually get to proudly disclose that I was one of the people on the committee that wrote this position statement, so I really understand the process whereby we came up with these conclusions. I know there is no perfect way to do this, but hopefully you will find these conclusions useful.

First off, what is the same? We always start treating our patients with lifestyle and metformin. After that doesn't work—and in many cases it is not enough—we then move to a second agent. It is at that level that these guidelines are a bit different,^[1] because we now include the sodium-glucose co-transporter 2 (SGLT2) inhibitor class at that step. Then we go on to third agents—to basal insulin—and then, finally, to more complicated insulin regimens.

In this particular algorithm, we try to tackle the point of moving to prandial insulin with a little more consideration, because for many patients, that step of adding mealtime insulin is quite complicated and may lead to hypoglycemia and weight gain.