Pharmacologic Approaches to Glycemic Treatment

3.2.9.0 Sec­tion 9

The sec­tion on the phar­ma­co­log­ic treat­ment of type 2 di­a­betes was significant­ly changed to align, as per the liv­ing Stan­dards up­date in Oc­to­ber 2018, with the ADA-‍EASD con­sen­sus re­port on this topic, sum­ma­rized in the new Figs. 9.1 and 9.2. This in­cludes con­sid­er­a­tion of key pa­tient fac­tors:

a) im­por­tant co­mor­bidi­ties such as ASCVD, chron­ic kid­ney dis­ease, and heart fail­ure, b) hy­po­glycemia risk, c) ef­fects on body weight, d) side ef­fects, e) costs, and f) pa­tient pref­er­ences.

To align with the ADA-‍EASD con­sen­sus re­port, the ap­proach to in­jectable med­i­ca­tion ther­a­py was re­vised (Fig. 9.2). A rec­om­men­da­tion that, for most pa­tients who need the greater efficacy of an in­jectable med­i­ca­tion, a glucagon-‍like pep­tide 1 re­cep­tor ag­o­nist should be the first choice, ahead of in­sulin.

A new sec­tion was added on in­sulin in­jec­tion tech­nique, em­pha­siz­ing the im­por­tance of tech­nique for ap­pro­pri­ate in­sulin dos­ing and the avoid­ance of com­pli­ca­tions (lipodys­tro­phy, etc.).

The sec­tion on nonin­sulin phar­ma­co­log­ic treat­ments for type 1 di­a­betes was ab­bre­vi­at­ed, as these are not gen­er­ally rec­om­mend­ed.