management of hyperglycemia in type 2

8/13/2019 Management of Hyperglycemia in Type 2

1/45

Management of Hyperglycemia in Type 2

Diabetes: A Patient-Centered Approach

Position Statement of the American Diabetes Association (ADA) and

the European Association for the Study of Diabetes (EASD)


2/45

Writing Group

American Diabetes Association

Richard M. Bergenstal MDIntl Diabetes Center, Minneapolis, MN

John B. Buse MD, PhD

University of North Carolina, Chapel Hill, NC

Anne L. Peters MDUniv. of Southern California, Los Angeles, CA

Richard Wender MDho!as "efferson University, #hila$elphia, #A

Silvio E. Inzucchi MD co!chair"%ale University, Ne& Haven, C

European Assoc. for the Study of Diabetes

Michaela Dia#ant MD, PhD'U University, A!ster$a!, he Netherlan$s

Ele $errannini MD

University of #isa, #isa, Italy

Michael %auc& MDDiabetes(entru!, )a$ Lauterberg, *er!any

A'ostolos (sa'as MD, PhDAristotle University, hessaloni+i, *reee

David R. Matthe)s MD, DPhil co!chair"-for$ University, -for$, U/


3/45

ADA-EASD Position Statement: Management of

Hyperglycemia in T2DM: A Patient-Centered Approach

1. PATIENT!ENTE"ED APP"#A!$

%. &A!'G"#(ND Epidemio)ogy and hea)th care impact

"e)ationship of g)ycemic contro) to outcomes #*er*ie+ of the pathogenesis of Type % diabetes

,. ANTI$-PE"G-!E/I! T$E"AP- G)ycemic targets

Therapeutic options ifesty)e #ra) agents 0 noninsu)in inectab)es

Insu)inDiabetes Care,Diabetologia. 19April 2012 [Epub ahead of print]


4/45

,. ANTI$-PE"G-!E/I! T$E"AP- Imp)ementation Strategies

Initia) drug therapy Ad*ancing to dua) combination therapy

Ad*ancing to trip)e combination therapy

Transitions to and titrations of insu)in

2. #T$E" !#NSIDE"ATI#NSAge

WeightSe34racia)4ethnic4genetic differences

!omorbidities (Coronary artery disease, Heart failure,Chronic kidney disease, Liver

dysfunction, Hypoglycemia)

5. 6(T("E DI"E!TI#NS 4 "ESEA"!$ NEEDS


Hyperglycemia in T2DM: A Patient-Centered Approach

Diabetes Care,Diabetologia. 19April 2012 [Epub ahead of print]


5/45


Hyperglycemia in T2DM

1. Patient!entered Approach

0...provi$ing are that is respetful of an$responsive to in$ivi$ual patient preferenes,nee$s, an$ values 1 ensuring that patient valuesgui$e all linial $eisions.2

Gauge patient7s preferred )e*e) ofin*o)*ement.

E3p)ore8 +here possib)e8 therapeuticchoices.

(ti)i9e decision aids.

Shared decision ma:ing ; fina) decisions reD /orta)ity

*+PDS D( -EDI

ACC-3D AD'ANC4

'AD ong Term 6o))o+up

Initia) Tria)

in (/DM


11/45



%. &A!'G"#(ND

#*er*ie+ of the pathogenesis ofT%D/

!Insu)in secretory dysfunction!Insu)in resistance ?musc)e8 fat8 )i*er@

!Increased endogenous g)ucose production

!Deranged adipocyte bio)ogy

!Decreased incretin effect



12/45

'eri'heralglucoseu'ta&e

he'aticglucose'roduction

'ancreaticinsulin

secretion'ancreaticglucagonsecretion

n Pathophysio)ogica) Defects in T%

gutcar0oh1dratedeliver1 2a0sor'tion

incretin

e33ect

!PE"#$!CE %A

Adapted from: Inzucchi SE, Sherwin RS in: Cecil Medicine 2011

ADA EASD P iti St t t M t f


13/45



,. ANTI$-PE"G-!E/I! T$E"AP-

G)ycemic targets! $bA1c B C.= #ean P4 /56!/76 #g-dl

89.:!9.; ##ol-l


14/45

igure 1 Diabetes Care,Diabetologia. 19April 2012 [Epub ahead of prin(Adapted with permission from: Ismail-Beigi F, et al.Ann Intern Med2011;154:554

ADA EASD P iti St t t M t f


15/45




Therapeutic options< ifesty)e

!Weight optimi9ation

!$ea)thy diet

!Increased acti*ity )e*e)


ADA EASD Position Statement: Management of


16/45




Therapeutic options

management of hyperglycemia in type 2

Documents