Journal List > J Korean Diabetes > v.19(2) > 1098207

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


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.

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.
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)


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.


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.
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