Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes
Silvio E. Inzucchi,Richard M. Bergenstal,John B. Buse,Michaela Diamant,Ele Ferrannini,Michael A. Nauck,Anne L. Peters,Apostolos Tsapas,Richard C. Wender,David R. Matthews +9 more
TLDR
This briefer article should be read as an addendum to the previous full account on the management of hyperglycemia, which described the need to individualize both treatment targets and treatment strategies with an emphasis on patient-centered care and shared decision making.Abstract:
In 2012, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a position statement on the management of hyperglycemia in patients with type 2 diabetes (1,2). This was needed because of an increasing array of antihyperglycemic drugs and growing uncertainty regarding their proper selection and sequence. Because of a paucity of comparative effectiveness research on long-term treatment outcomes with many of these medications, the 2012 publication was less prescriptive than prior consensus reports. We previously described the need to individualize both treatment targets and treatment strategies, with an emphasis on patient-centered care and shared decision making, and this continues to be our position, although there are now more head-to-head trials that show slight variance between agents with regard to glucose-lowering effects. Nevertheless, these differences are often small and would be unlikely to reflect any definite differential effect in an individual patient.
The ADA and EASD have requested an update to the position statement incorporating new data from recent clinical trials. Between June and September of 2014, the Writing Group reconvened, including one face-to-face meeting, to discuss the changes. An entirely new statement was felt to be unnecessary. Instead, the group focused on those areas where revisions were suggested by a changing evidence base. This briefer article should therefore be read as an addendum to the previous full account (1,2).
Glucose control remains a major focus in the management of patients with type 2 diabetes. However, this should always be in the context of a comprehensive cardiovascular risk factor reduction program, to include smoking cessation and the adoption of other healthy lifestyle habits, blood pressure control, lipid management with priority to statin medications, and, in some circumstances, antiplatelet therapy. Studies have conclusively determined that reducing hyperglycemia decreases the onset and progression of …read more
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Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)
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TL;DR: In this article, the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a randomised controlled trial were compared.
Journal Article
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group.
R C Turner,C Fox,Matthews,H McElroy,Carole A. Cull,Rury R. Holman,P. A. Neil,D R Hadden,D Wright,E Manley,Irene M Stratton,UK Prospective Diabetes,E M Kohner,Frighi,Michael Gnant +14 more
TL;DR: The effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a randomised controlled trial were compared.
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Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study
Irene M Stratton,Amanda I Adler,H. Andrew W. Neil,David R. Matthews,Susan E. Manley,Carole A. Cull,D R Hadden,Robert C Turner,Rury R. Holman +8 more
TL;DR: In patients with type 2 diabetes the risk of diabetic complications was strongly associated with previous hyperglycaemia, with the lowest risk being in those with HbA1c values in the normal range (<6.0%).
Journal Article
Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34)
R C Turner,Rury R. Holman,Irene M Stratton,Carole A. Cull,David R Matthews,Susan E. Manley,V Frighi,D Wright,Andrew Neil,E M Kohner,H McElroy,C Fox,D R Hadden,Grp Ukpds. +13 more
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Effects of intensive glucose lowering in type 2 diabetes
Hertzel C. Gerstein,Michael Miller,Robert P. Byington,David C. Goff,J. Thomas Bigger,John B. Buse,William C. Cushman,Saul Genuth,Faramarz Ismail-Beigi,Faramarz Ismail-Beigi,Richard H. Grimm,Jeffrey L. Probstfield,Denise G. Simons-Morton,William T. Friedewald +13 more
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