In a 2020 American Diabetes Association clinical guideline, published online Sept. 1 in the Annals of Internal Medicine, recommendations are presented for the pharmacologic treatment of adults with type 2 diabetes.
Kacie Doyle-Delgado, D.N.P., from St. Mark’s Hospital and St. Mark’s Diabetes Center in Salt Lake City, and colleagues updated recommendations relating to the pharmacologic treatment of adults with type 2 diabetes based on a review of the recent evidence.
The authors note that the initial pharmacologic agent preferred for treatment of type 2 diabetes is metformin. In some patients, early combination therapy is recommended at treatment initiation to extend time to treatment failure. In the case of evidence of ongoing catabolism (weight loss), if symptoms of hyperglycemia are present, or when hemoglobin A1c or blood glucose levels are very high, early introduction of insulin should be considered. To guide the choice of pharmacologic agents, a patient-centered approach should be used. A sodium-glucose cotransporter-2 inhibitor or glucagon-like peptide-1 receptor agonist (GLP-1 RA) with demonstrated cardiovascular disease benefit is recommended for patients with type 2 diabetes who have established atherosclerotic cardiovascular disease or indicators of high risk, established kidney disease, or heart failure. GLP-1 RAs are preferred to insulin in patients with type 2 diabetes who need greater glucose lowering than can be obtained with oral agents.
“The medication regimen and medication-taking behavior should be reevaluated at regular intervals (every three to six months) and adjusted as needed to incorporate specific factors that affect choice of treatment,” the authors write.