The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) announced on Friday 23 September 2022 the release of new consensus recommendations on the management of hyperglycemia in type 2 diabetes (T2D).
The latest update to the Joint Guidelines focuses on a more holistic, person-centered approach to the care of people with T2D including an appreciation of equality of care.
The update, according to the introduction, was reported through a systematic review of the evidence published since 2018. Building on the analysis, the new recommendations include a new focus on social determinants of health and the role of the public health care system in the management of T2D disease. The statement notes that the former is often beyond the control of individuals and potentially represents a lifelong risk that must be incorporated into decisions about care.
lifestyle. There is also an expanded focus on the role of lifestyle modifications in managing hyperglycemia and maintaining optimal health, including additional guidance on physical activity, for example, daily light exercise or resistance training every 30 minutes while seated, achieving an additional 500 steps per day Strength training 2-3 times a week, the importance of quantity (6-9 hours/night) and quality of sleep.
weight management. There is a deep and greatly expanding focus on weight management as central to managing hyperglycemia as well as to improving and/or preventing diseases associated with T2D, such as cardiovascular disease and atherosclerosis, heart failure, chronic kidney disease, and for the first time including non-alcoholic fats. Liver disease. Weight reduction in the consensus statement is a targeted intervention and a 5 to 15% loss should be a primary management goal for many people with T2D, the authors wrote.
Heart protection. An extended set of recommendations for cardio-renal protection in T2D patients at high risk for both types of cardiovascular disease has been reported by clinical trials especially cardiovascular and renal outcome trials with sodium glucose transporter 2 (SGLT-2) and glucagon-like peptide-agonists. Receptor 1 (GLP-1 RA), including assessment of important patient subpopulations. Other updates include recommendations on the use of oral GLP-1 RAs, guidance on the new class of dual GIP/GLP-1 RAs, and appropriate use of GLP-1 RA/insulin combination therapy.
There are many other topics related to person-centered care that are covered throughout the new report including guidance on the use of language clinicians when discussing care with patients (eg, impartial, fact-based, and free of bias); Ensure access to education and support in diabetes self-management; Considering the local care environment and available resources, adapting specifically to and avoiding clinical inertia
Synthesis plus routing. in version ADA meeting news Of the eighty-second science sessions held in June, Robert Gabbay, MD, ADA’s chief scientific and medical officer, promised that the update would include “more information on the practical aspects of implementation than we’ve included in previous updates. The entire joint effort is not just to compile evidence for clinicians, but also to give them the tools to bring this into their practice and improve the lives of people with diabetes.”
In today’s announcement, he continues, “The extensive report has many new features. It not only talks about what needs to be done, but also has a section on how to implement these changes.”
Gabbay refers in part to a new section that follows each set of recommendations titled Clinical advice for doctorsbasically a bulleted list of “how-to’s” to help guide next steps.
In addition to access to document recommendations, there are 6 full-page color graphics that summarize specific aspects of T2D care and management and include quick profiles of all current classes of glucose-lowering agents, a comprehensive T2D optimal approach to person-centered administration and recommendations for initiating insulin therapy.
The update was prepared by an international panel of experts including John P. Bose, MD, PhD, (University of North Carolina School of Medicine, Chapel Hill, NC); Melanie J. Davies, CBE, MBChB, MD (Leicester Diabetes Centre, Leicester, UK); and their colleagues.