From the Research
The 2024 American Diabetes Association (ADA) guidelines strongly recommend GLP-1 receptor agonists or SGLT2 inhibitors as first-line pharmacotherapy for type 2 diabetes, especially for patients with established cardiovascular disease, heart failure, or chronic kidney disease, due to their proven benefits in reducing morbidity, mortality, and improving quality of life 1, 2, 3. The guidelines emphasize a patient-centered approach to diabetes management, with several key updates.
- The guidelines recommend screening for prediabetes and type 2 diabetes in all adults starting at age 35, with earlier screening for those with risk factors.
- For glycemic targets, the ADA recommends an A1C goal of <7% for most adults, with more stringent targets (<6.5%) for selected patients if achievable without significant hypoglycemia, and less stringent goals (<8%) for patients with limited life expectancy or severe comorbidities.
- The guidelines emphasize comprehensive cardiovascular risk management including blood pressure targets <130/80 mmHg, statin therapy based on risk assessment, and use of medications with proven cardiovascular benefits.
- For diabetes technology, continuous glucose monitoring is recommended for all patients on intensive insulin therapy.
- The guidelines also highlight the importance of addressing social determinants of health, mental health screening, and lifestyle modifications including medical nutrition therapy, physical activity (150 minutes of moderate-intensity exercise weekly), and weight management, with recognition of obesity medications and metabolic surgery as effective treatment options for appropriate candidates. The most recent and highest quality study, an umbrella review published in 2024, found that the combination of GLP-1 receptor agonists, SGLT2 inhibitors, and DPP-4 inhibitors can effectively lower HbA1c and FPG in T2DM patients who have poor therapeutic effects on basic insulin combined with metformin/sulfonylureas 1. Additionally, a network meta-analysis published in 2023 found that SGLT2 inhibitors and GLP-1 receptor agonists showed beneficial effects on mortality and major cardiovascular adverse events compared to DPP-4 inhibitors and sulfonylureas 2. Another study published in 2023 found that both SGLT2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of major adverse cardiovascular events when compared with DPP-4 inhibitors or sulfonylureas 3. Overall, the evidence supports the use of GLP-1 receptor agonists or SGLT2 inhibitors as first-line pharmacotherapy for type 2 diabetes, due to their proven benefits in reducing morbidity, mortality, and improving quality of life.