Clinical Edge

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Treatment Intensification Guidelines for T2D

Ann Intern Med; ePub 2018 Sep 4; Roglic, et al

The World Health Organization (WHO) has developed guidelines to provide guidance on selection of medicines for treatment intensification in type 2 diabetes (T2D) and on use of insulin in type 1 and 2 diabetes. The recommendations were formulated by a 12-member guideline development group and are based on high-quality systematic reviews from January 1, 2007 to March 2017. The recommendations include:

  • Give a sulfonylurea to patients with T2D who do not achieve glycemic control with metformin alone or who have contraindications to metformin (strong recommendation, moderate-quality evidence).
  • Introduce human insulin treatment to patients with T2D who do not achieve glycemic control with metformin and/or a sulfonylurea (strong recommendation, very-low-quality evidence).
  • If insulin is unsuitable, a dipeptidyl peptidase-4 (DPP-4) inhibitor, a sodium–glucose cotransporter-2 (SGLT-2) inhibitor, or a thiazolidinedione (TZD) may be added (weak recommendation, very-low-quality evidence).
  • Use human insulin to manage blood glucose in adults with type 1 diabetes and in adults with T2D for whom insulin is indicated (strong recommendation, low-quality evidence).
  • Consider long-acting insulin analogues to manage blood glucose in adults with type 1 or T2D who have frequent severe hypoglycemia with human insulin (weak recommendation, moderate-quality evidence for severe hypoglycemia).

Citation:

Roglic G, Norris SL. Medicines for treatment intensification in type 2 diabetes and type of insulin in type 1 and type 2 diabetes in low-resource settings: Synopsis of the World Health Organization Guidelines on second- and third-line medicines and type of insulin for the control of blood glucose levels in nonpregnant adults with diabetes mellitus. Ann Intern Med. [Published online ahead of print September 4, 2018]. doi:10.7326/M18-1149.

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