Lifestyle management prioritised in new ADA guidelines for type 2 diabetes

Experts have produced a new document calling for better management of blood glucose levels in people with type 2 diabetes
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have jointly developed the guidelines, which were presented at the EASD Annual Meeting in Berli, Germany.
The authors’ report includes guidance on optimising blood glucose control, reducing the risk of serious complications and improving health outcomes. It follows a review of nearly 500 manuscripts over the last four years, with a particular focus on cardiovascular outcome trials.
Lifestyle management and availability of structured education programs have been highlighted as being critically important for overall health. Specifically, the authors state that healthy eating advice and strategies should be made available to everyone with type 2 diabetes.
Significantly, the report also brought the welcoming news that a low carbohydrate diet is recognised as a safe and effective treatment for people with type 2 diabetes.
Those who are overweight or obese should be shown how the health benefits of weight loss can improve their health and reduce the risk of complications, the report says.
The focus on the choice of medications prescribed is also significant. Metformin remains the preferred first-line treatment for type 2 diabetes, alongside making healthy lifestyle choices, while glucagon-like peptide 1 (GLP-1) receptor agonists are now recommended as the first injectable medication prior to insulin for most adults with type 2.
Both SGLT2 inhibitors and GLP-1 agonists have been recommended for people with type 2 diabetes and cardiovascular disease. SGLT2 drugs have also been recommended for people with chronic kidney disease.
Ultimately though, patient preference should be prioritised when being prescribed medication.
Target HbA1c levels are 53 mmol/mol (7%) or below for most non-pregnant adults. The researchers believe this target should help people achieve heart benefits, among other positive health outcomes.
“The management of hyperglycemia in type 2 diabetes has become extraordinarily complex with the number of glucose-lowering medications now available,” said the authors. “Patient-centred decision making and support and consistent efforts to improve diet and exercise remain the foundation of all glycemic management.”
William T. Cefalu, MD, Chief Scientific, Medical and Mission Officer at the ADA, said: “We are proud to call for this paradigm shift as the most logical and appropriate next steps in care through this joint consensus report with EASD.
“The needs of our patients require that we consider the many individual life factors in order to improve quality and length of life for as many people as possible.”
The report has been published in the journal Diabetes Care.