Sec­tion 9. Phar­ma­co­log­ic Ap­proach­es to Glycemic Treat­ment

(https:/​/​doi.org/​10.2337/​dc23-​S009)

Sec­tion 9 was up­dat­ed to align with the lat­est con­sen­sus re­port on man­age­ment of hy­per­glycemia in type 2 di­a­betes by the Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) and the Eu­ro­pean As­so­ci­a­tion for the Study of Di­a­betes (EASD). Rec­om­men­da­tion 9.4a was added to state that healthy lifestyle behaviors, DSMES, avoid­ance of clin­i­cal in­er­tia, and so­cial de­termi­nants of health (SDOH) should be con­sid­ered in the glu­cose-​low­er­ing man­age­ment of type 2 di­a­betes.

Rec­om­men­da­tion 9.4b was added to in­di­cate that in adults with type 2 di­a­betes and es­tab­lished/​high risk of atheroscle­rot­ic car­dio­vas­cu­lar dis­ease, heart fail­ure, and/​or chron­ic kid­ney dis­ease, the treat­ment plan should in­clude agents that re­duce car­diore­nal risk.

Rec­om­men­da­tion 9.4c was added to ad­dress the con­sid­er­a­tion of phar­ma­co­log­ic ap­proach­es that pro­vide the efficacy to achieve treat­ment goals.

Rec­om­men­da­tion 9.4d was added to ad­dress weight man­age­ment as an im­pact­ful com­po­nent of glu­cose-​low­er­ing man­age­ment in type 2 di­a­betes.

In­for­ma­tion was added to ad­dress con­sid­er­a­tions for a GLP-​1 re­cep­tor ag­o­nist pri­or to pran­di­al in­sulin to fur­ther ad­dress pran­di­al con­trol and to min­i­mize the risks of hy­po­glycemia and weight gain as­so­ci­at­ed with in­sulin ther­a­py.

In­for­ma­tion was added to ad­dress al­ter­na­tive in­sulin routes.

Table 9.2 and Fig. 9.3 were up­dat­ed based on the lat­est con­sen­sus re­port on man­age­ment of hy­per­glycemia in type 2 di­a­betes by the ADA and the EASD.