American Diabetes Association, European Association For The Study Of Diabetes Publish Consensus Algorithm For Type 2 Diabetes Treatment

Main Category: Diabetes
Article Date: 23 Oct 2008 - 5:00 PDT

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A panel of experts convened by the American Diabetes Association and the European Association for the Study of Diabetes has issued updated treatment recommendations for type 2 diabetes, in a consensus statement being published online today in the journals Diabetes Care and Diabetologia.

The revisions to the diabetes treatment algorithm, first published in 2006, provide guidance to health care providers for treating type 2 diabetes, taking into account new medications that have come on the market and the most current scientific data regarding previously recommended drugs.

The algorithm describes a stepped-care approach to treat the elevated levels of blood glucose and A1C, a measure of average glucose levels during the previous two to three months that characterize diabetes. The consensus statement authors again suggest lifestyle changes and metformin as the initial treatment to help people newly diagnosed with type 2 diabetes achieve A1C goals.  The lifestyle intervention and metformin are usually continued throughout the treatment course. However, if glucose/glycemic goals are not met, or not maintained over time, the algorithm progresses to Step 2 and provides two choices.  The first choice, which is preferred and well validated, calls for the addition of basal insulin or a sulfonylurea to lifestyle changes and metformin.  The second choice includes the addition of pioglitazone or a GLP-1 agonist to lifestyle changes and metformin.  If the Step 2 choices do not maintain A1C goals, the panel suggests initiation of basal insulin, if not already started, and then transition to intensive insulin (Step 3), if needed.  As in the original algorithm, all of the transitions in therapy usually occur at 3-month intervals, aiming for rapid achievement and continuous maintenance of near-normal glucose and A1C levels.

"Excellent glycemic control is critical to prevent the long-term complications associated with diabetes, which can lead to loss of vision, kidney failure, and amputations," said Dr. David M. Nathan, Chair of the Panel.   "After much deliberation, we intentionally chose therapies we highly recommend as safe, effective, and that have much evidence supporting their use.  The second tier drugs are valuable if hypoglycemia is a major concern, but the use of these drugs is less validated."

Prof. Ele Ferrannini, Past President of EASD, said, "This joint EASD/ADA statement on the treatment of type 2 diabetes is an effort to represent the latest  scientific evidence relevant to the use of blood glucose lowering agents in the hope of providing comprehensive guidance to clinicians."

Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into one of the nation's leading causes of death by disease.  Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations.

The American Diabetes Association is leading the fight against the deadly consequences of diabetes and fighting for those affected by diabetes.  The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes.  Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.  For more information, please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit http://www.diabetes.org.  Information from both these sources is available in English and Spanish.

Diabetologia, the official journal of EASD, is the leading publication in Europe for clinical and basic diabetes research and conveys new information and insights into the condition, ranging from basic science to clinical applications.

The EASD was founded in 1965 and its annual diabetes meeting brings together the largest international audience of diabetologists.  In 2008, the EASD Annual Meeting was attended by over 18,000 participants from 124 countries.  EASD generously funds travel grants to young presenters from all over the world, numerous postgraduate activities in Europe and beyond and works closely with European research institutions.  EASD has never been restricted by the borders of Europe and its membership is open to all nationalities.  The European Foundation for the Study of Diabetes, which was founded by the EASD, has committed over 55 million Euros to diabetes research and cooperates with partners from industry and other with non-profit organisations.

http://www.easd.org