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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 05/10/2018

Figure 2 of consensus report

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

In this issue, the 2018 joint ADA/EASD consensus report (https://doi.org/10.1007/s00125-018-4729-5) incorporates a comprehensive review of the literature from 2014 and interprets this new evidence into a series of pragmatic, practical road maps to help clinicians navigate the increasingly complex area of management of hyperglycaemia in adults with type 2 diabetes. It emphasises the patient-centred approach to care and recognises the ongoing therapeutic value of comprehensive lifestyle management and patient self-management education.

Since 2015, the rapid accumulation of evidence, particularly from cardiovascular outcomes trials, has clearly demonstrated that some glucose-lowering agents confer cardiovascular outcome benefit. These findings have precipitated a fundamental change in approach. For an increasing number of patients, the presence of specific comorbidities (e.g. atherosclerotic cardiovascular disease, chronic kidney disease, heart failure, obesity), safety concerns (e.g. risk of hypoglycaemia) or the healthcare environment (e.g. cost of medication) mandate a specific approach to the choice of glucose-lowering medication, and recommendations are given in this report. The report also tackles important barriers to improving patient outcomes, such as therapeutic inertia and medication adherence, including persistence. It explains that patient preference is a major factor driving the choice of medication and that a coordinated chronic care model that promotes interaction between more empowered patients and proactive healthcare teams is central to improving outcomes.

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