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2019 update to: Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) – published online 19/12/2018

Image from Buse paper

John B. Buse, Deborah J. Wexler, Apostolos Tsapas, Peter Rossing, Geltrude Mingrone, Chantal Mathieu, David A. D’Alessio, Melanie J. Davies

In 2018, the ADA/EASD published a consensus report for the management of hyperglycaemia in type 2 diabetes (https://link.springer.com/article/10.1007/s00125-018-4729-5). Patient-centred care that was focused on reducing the burden of complications represented a paradigm shift in the approach to diabetes management, with the preferred use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and sodium–glucose cotransporter 2 (SGLT2) inhibitors in those with established atherosclerotic cardiovascular disease (ASCVD). Since then, there has been an unprecedented release of new outcome data, mandating a brief update to the 2018 consensus. In this issue, the ADA/EASD (https://doi.org/10.1007/s00125-019-05039-w) present important changes to the 2018 consensus, including consideration of GLP-1 RAs and SGLT2 inhibitors for beneficial cardiorenal outcomes in individuals with type 2 diabetes, independently of HbA1c levels. Where major adverse cardiovascular events are the gravest threat, the evidence favours the preferred use of GLP-1 RAs; as well as being used in those with type 2 diabetes and established ASCVD, their use should be considered in those with specific indicators of high cardiovascular risk. When it comes to the use of SGLT-2 inhibitors in type 2 diabetes, the evidence is now much clearer for their benefit, particularly in those with heart failure with reduced ejection fraction and in those with chronic kidney disease (CKD), and in the prevention of CKD progression. Thus, SGLT-2 inhibitors are preferred for diabetes management in individuals with these comorbidities.

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