New guidance statements published online ahead of print in October 2018 in Diabetes Care highlight the importance of lifestyle modifications and self-management, with a focus on support and education to ensure success. Of the lifestyle modifications, focused efforts targeting weight loss are central to the newest guidelines.
Lead author, Professor Melanie J. Davies, CBE, MB, ChB, MD, FRCP, FRCGP, affiliated with the Diabetes Research Centre, University of Leicester, Leicester, UK, and the Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK, and her team underscore the importance of healthcare providers prioritizing the delivery of patient-centered care and offering access to ongoing programs following that approach.
The consensus recommendations also reaffirm the importance of using metformin, which is still the preferred initial glucose-lowering medication for most people with type 2 diabetes. However, the selection of add-on therapy should be based not only on clinical factors, but also on patient preferences. These references include willingness to take more medication, insurance coverage, and the bottom-line costs of the prescription for the patient. The team reminds providers managing diabetes that they should consider stepwise additions of augmentation therapy rather than starting with an initial combination.
According to the cochair of the expert panel, John Buse, MD, PhD, the Verne S. Caviness Distinguished Professor and chief of endocrinology at the University of North Carolina School of Medicine in Chapel Hill, it is “important for all patients to know the focus of care is shifting to better account for the individual needs and preferences of patients, along with an effort to actively engage patients to take a more active role in educating themselves about the disease and managing it.”
Some clinical conditions were associated with specific recommendations, including the use of a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a glucagon-like peptide receptor agonist with proven cardiovascular benefit for patients with clinical cardiovascular disease. The guidelines also recommend using SGLT2 inhibitors with proven benefit for patients with clinical heart failure and atherosclerotic disease or chronic kidney disease.
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