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Park: Paradigm Changes in Diabetes Management Guidelines: American Diabetes Association 2018
Opinion

The Journal of Korean Diabetes 2018; 19(2): 71-75.

Published online: 30 June 2018

DOI: https://doi.org/10.4093/jkd.2018.19.2.71

Paradigm Changes in Diabetes Management Guidelines: American Diabetes Association 2018

Jeong Hyun Park

Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Corresponding author: Jeong Hyun Park. Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea, pjhdoc@chol.com

Received 27 April 2018       Accepted 22 May 2018

Copyright © 2018 Korean Diabetes Association

Korean Diabetes Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The management of type 2 diabetes mellitus should comprise healthy lifestyle modifications along with tailored pharmacologic treatment. Traditionally, the American Diabetes Association (ADA)'s Diabetes Management Guidelines have not prioritized specific anti-diabetic drugs over others with regard to cardiovascular disease (CVD) and mortality prevention. Recently, two novel anti-diabetic medications proved to be significantly protective against future CVD and mortality, regardless of the glycemic levels achieved in type 2 diabetic patients with pre-existing CVD. The 2018 ADA Guidelines recommend SGLT2 inhibitor and/or GLP-1 receptor agonist be used for type 2 diabetes patients with atherosclerotic CVD after metformin monotherapy failure. Considering the value of CVD protection in the management of diabetes mellitus, this minor guideline adjustment could have far-reaching implications.

Keywords: Agonist, Cardiovascular diseases, Diabetes mellitus, Glucagon-like peptide-1 receptor, Inhibitor, Mortality, Sodium-glucose transporter 2

Figures and Tables

Fig. 1

The American Diabetes Association 2018 antihyperglycemic therapy in type 2 diabetes: general recommendations. Adapted from the article of American Diabetes Association (Diabetes Care 2018;41:S73–85) [1] with original copyright holder's permission.

A1C, HbA1c; ASCVD, atherosclerotic cardiovascular disease.
jkd-19-71-g001
Table 1

Drug-specific and patient factors to consider when selecting antihyperglycemic treatment in adults with type 2 diabetes (SGLT2 inhibitor and GLP-1 RA)

jkd-19-71-i001

Adapted from the article of American Diabetes Association (Diabetes Care 2018;41:S73–85) [1] with original copyright holder's permission.

CV, cardiovascular; ASCVD, atherosclerotic cardiovascular disease; CHF, congestive heart failure; SQ, subcutaneous; RAs, receptor agonists.

References

1. American Diabetes Association. 8. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018; 41:Suppl 1. S73–S85.
2. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, Mattheus M, Devins T, Johansen OE, Woerle HJ, Broedl UC, Inzucchi SE. EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015; 373:2117–2128.
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3. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, Nissen SE, Pocock S, Poulter NR, Ravn LS, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Buse JB. LEADER Steering Committee. LEADER Trial Investigators. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016; 375:311–322.
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