2020 ADA Standards: A 'New Concept' in Treating T2D

This transcript has been edited for clarity.

Today I'm going to continue my overview of the 2020 American Diabetes Association (ADA) Standards of Medical Care in Diabetes.

Pharmacologic approaches to the management of glycemia in patients with type 2 diabetes (T2D) are discussed in section 9. This section is mistitled, because diabetologists in 2020 are now looking at two things: glycemic management, to be sure, but also cardiovascular risk reduction. As everyone now knows, our diabetes drugs do two things: They lower glucose levels and they lower the risk for cardiovascular events, heart failure, and progression to chronic kidney disease (CKD). So the world of cardiology and the world of diabetes are getting closer.

The cardiologists have changed their guidelines, essentially throwing out metformin and instead using GLP-1 receptor agonists and SGLT2 inhibitors as first-line therapy in patients who have other high-risk characteristics such as existing CKD, atherosclerotic cardiovascular disease (CVD), or heart failure. The ADA still sticks with metformin as the first-line therapy for patients with T2D, but they also say that if a patient has those high-risk characteristics (established CVD, CKD, or heart failure), don't bother looking at the A1cgo ahead and also start them on a GLP-1 receptor agonist or an SGLT2 inhibitor.