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Abstract
In 2012, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published new guidelines for the management of type 2 diabetes, emphasizing the need to individualize treatment goals with preference, need and cost-effects compared with the 2008 ADA/EASD algorithm. These ADA/EASD recommendations provided characteristics of medications in view of improved pharmacodynamics, effects, side effect and cost. The ADA/EASD explained stratification of treatment based on HbA1c and no preferred sequential order for regimens involving dual and triple therapy, indicating the strong effects of insulin therapy in the case of triple therapy. In this section, we summarize "Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes" in Korean.
Figures and Tables
Fig. 1
Depiction of the elements of decision making used to determine appropriate efforts to achieve glycemic targets. Adapted from Inzucchi et al. Diabetes Care 2012;35:1364-79 [1].
Fig. 2
Antihyperglycemic therapy in type 2 diabetes: general recommendations. Moving from the top to the bottom of the figure, potential sequences of antihyperglycemic therapy. Adapted from Inzucchi et al. Diabetes Care 2012;35:1364-79 [1].
Fig. 3
Sequential insulin strategies in type 2 diabetes. Basal insulin alone is usually the optimal initial regimen. In patients willing to take more than one injection and who have higher HbA1c levels (≥ 9.0%), twice-daily premixed insulin or a more advanced basal plus mealtime insulin regimen could also be considered (curved dashed arrow lines). When basal insulin has been titrated to an acceptable fasting glucose but HbA1c remains above target, consider proceeding to basal plus mealtime insulin, consisting of one to three injections of rapid-acting analogs. A less studied alternative-progression from basal insulin to a twice-daily premixed insulin-could be also considered (straight dashed arrow line); if this is unsuccessful, move to basal plus mealtime insulin. Adapted from Inzucchi et al. Diabetes Care 2012;35:1364-79 [1].
Table 1
Properties of currently available glucose-lowering agents that may guide treatment choice in individual patients with type 2 diabetes mellitus. Adapted from Inzucchi et al. Diabetes Care 2012;35:1364-79 [1].
aLimited use in the U.S./Europe. bNotlicensed in the U.S. cPrescribing highly restricted in the U.S.;with drawn in Europe. dNotlicensed in Europe. eTo be available as a generic product in 2012, with expected significant reductions in cost. fDepends on type (analogs > human insulins) and dosage;CKD,chronickidneydisease;CVD, cardiovascular disease;DPP-4, dipeptidyl peptidase 4;GIP, glucose-dependent insulinotropic peptide; GLP-1, glucagon-like peptide1;HDL-C, HDL-cholesterol;LDL-C, LDL-cholesterol;PPAR, peroxisome proliferator-activated receptor;ProACTIVE, ProspectivePioglitazone Clinical Trialin Macrovascular Events(60); STOP-NIDDM, Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (134);UKPDS, UK Prospective DiabetesStudy (29-33).
References
1. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR. American Diabetes Association (ADA). European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012. 35:1364–1379.
2. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012. 55:1577–1596.
3. Rodbard HW, Jellinger PS. Comment on: Inzucchi et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364-1379. Diabetes Care. 2012. 35:e70.
4. Ismail-Beigi F, Moghissi E, Tiktin M, Hirsch IB, Inzucchi SE, Genuth S. Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann Intern Med. 2011. 154:554–559.
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