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Title: Updated Treatment Recommendations for Type 2 Diabetes Released
URL: http://www.pslgroup.com/dg/2313F6.htm
Doctor's Guide
October 22, 2008

ALEXANDRIA, Va -- October 22, 2008 -- 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. 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 2 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 panel member David M. Nathan, MD, Harvard Medical School, Boston, Massachusetts.

"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."

SOURCE: American Diabetes Association

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