From the Guidelines
Current Guidelines for Diabetes Mellitus (DM) Type Management in 2024: The current guidelines recommend a person-centered shared decision-making approach to guide the choice of pharmacologic agents for adults with type 2 diabetes, considering factors such as cardiovascular and renal comorbidities, effectiveness, hypoglycemia risk, impact on weight, cost, and access, as well as individual preferences 1.
Key Recommendations
- Medication plans should be reevaluated at regular intervals (every 3-6 months) and adjusted as needed to incorporate specific factors that impact choice of treatment 1.
- Early combination therapy can be considered in adults with type 2 diabetes at treatment initiation to shorten time to attainment of individualized treatment goals 1.
- For adults with type 2 diabetes who have heart failure (HF), an SGLT2 inhibitor is recommended for glycemic management and prevention of HF hospitalizations 1.
- The glucose-lowering treatment plan should consider approaches that support weight management goals for adults with type 2 diabetes, including intensification of lifestyle modifications, structured weight management programs, pharmacologic agents, or metabolic surgery, as appropriate 1.
- Pharmacologic agents should be selected based on their ability to address both individualized glycemic and weight goals, as well as the presence of other metabolic comorbidities and the risk of hypoglycemia 1.
From the FDA Drug Label
As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus To reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease To reduce the risk of end-stage kidney disease, doubling of serum creatinine, cardiovascular death, and hospitalization for heart failure in adults with type 2 diabetes mellitus and diabetic nephropathy with albuminuria
The current guidelines for Diabetes Mellitus (DM) type 2 management in 2024 include:
- Using SGLT2 inhibitors like canagliflozin as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus 2
- Using insulin like insulin glargine to improve glycemic control in adult and pediatric patients with diabetes mellitus, individualizing dosage based on metabolic needs, blood glucose monitoring, glycemic control, type of diabetes, and prior insulin use 3
- Using insulin detemir to improve glycemic control, with dosage adjustments as necessary based on patient needs and response to therapy 4 Key points to consider:
- Diet and exercise are essential components of DM type 2 management
- Medication should be individualized based on patient needs and response to therapy
- Monitoring of blood glucose, kidney function, and other health parameters is crucial to adjust treatment plans as needed
- Concomitant use of other medications, such as insulin or insulin secretagogues, may require dose adjustments to reduce the risk of hypoglycemia 2
From the Research
Current Guidelines for Diabetes Mellitus (DM) Type Management
The current guidelines for Diabetes Mellitus (DM) type management recommend metformin as the first-line pharmacological therapy for type 2 diabetes 5, 6, 7.
Second-Line Therapy
For second-line therapy, the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) guidelines recommend SGLT2 inhibitors or GLP1 RAs for patients with atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease 5.
- Other options for second-line therapy include:
- The choice of second-line therapy should be individualized based on patient characteristics, such as the presence of cardiovascular disease or chronic kidney disease 5, 6.
Combination Therapy
Early combination therapy with metformin and another glucose-lowering agent may be beneficial for patients with type 2 diabetes, particularly those with higher baseline A1c levels 8.
- The combination of metformin and SGLT2 inhibitors may be a good option for improving glycemic control with a low risk of hypoglycemia, but it may also increase the risk of metabolic acidosis 9.
Metformin Use
Metformin is recommended as a foundation therapy for type 2 diabetes, with emphasis on avoidance of therapeutic inertia and early attainment of multiple treatment goals 6.
- Metformin has been shown to have glucose-lowering and cardiovascular-renal benefits, with an extremely low risk of lactic acidosis 6.
- The use of metformin should be optimized by understanding its interactions with foods and microbiota, and mitigating potential side effects such as gastrointestinal side effects and vitamin B12 deficiency 6.