Type 2 diabetes mellitus recommendations


Guidelines provide physicians with guidance, not ultimatums, on how to treat various conditions. When multiple different guidelines exist, confusion may ensue among patients, physicians, and others. Such is the case with treatment of type 2 diabetes mellitus: The American College of Physicians, the national organization of internists and subspecialities including endocrinologists, suggest loosening target aic from <6.5% to 7-8% for most patients. The American Diabetes Association suggests a target aic <7% for most patients, and the American College of Endocrinology recommends an aic target of<6.5%. Who should we believe?

Simply said, we should believe all of them. Diabetes treatment needs to be individually tailored.

These groups agree that those at risk of hypoglycemia should, in general, have looser targets, as should those with shorter life expectancy, and an absence of complications.

Conversely, those patients with microvascular complications, e.g. retinopathy, neuropathy, and nephropathy, should be treated more aggressively. Microvascular complications seem to correlate more strongly with higher AIC. Macrovascular disease, e.g.cardiovascular events, meaning acute coronary syndromes, stroke, and peripheral arterial disease, seem to correlate less with aic reduction, though risk may be diminished not only with lifestyle changes, but also certain diabetes medications. Metformin, certain sodium-glucose co-transporter 2 inhibitors inhibitors, and glucagon-like peptide1 agonists have been shown to reduce cardiovascular events in some settings.

Diet and exercise remain the most important aspects of the treatment of type 2 diabetes mellitis. Most would suggest metformin, because of its long track record, the UKPDS clinical trials with subgroup analysis remains first line therapy for those without contraindications or intolerance. After this, many organizations frequently provide many recommendations for second line therapy, recent studies demonstrating reduced cardiovascular events with SGLT2 inhibitors and GLP1 agonists more attractive to be a part of an individualized care plan.