medwireNews: The latest update to the ADA and EASD hyperglycemia management consensus report places a strong emphasis on holistic, person-centered care for type 2 diabetes.
Introducing the new consensus statement at the 58th EASD Annual Meeting in Stockholm, Sweden, ADA Chief Science and Medical Officer Robert Gabbay described this iteration as “perhaps the best yet.”
Co-lead author Melanie Davies (University of Leicester, UK) said that the team placed a particular focus on social determinants of health, the healthcare system, holistic, person-centered care, quality of care, and also weight management “as an essential component of comprehensive care.”
The identified social determinants comprise socioeconomic status, living and working conditions, multisector domains (such as housing and education), sociocultural context, and sociopolitical context, such as societal and political ideologies and policies that can underlie health disparities.
The report also stresses the importance of appropriate language, which should be neutral, fact-based, and free of stigma, and encourage person-centered collaborative care.
Holistic care consists of cardiorenal protection, cardiovascular risk factor management, weight management, and blood glucose management, with all of these elements of equal importance. Therapeutic inertia is addressed and liver complications make their first appearance.
The authors also highlight the importance of people with type 2 diabetes addressing physical behaviors throughout the day and night, including breaking up prolonged sitting, increasing step count, and undertaking resistance training in addition to aerobic exercise. Another newly included element is sleep – both quality and quantity – in which people’s natural chronotypes should be taken into account.
In addition, the updated report includes “a consolidation of evidence from the outcome studies,” said Davies. The experts behind the statement reviewed publications up to June 2022 to form the basis of their latest advice.
Of note, the statement no longer recommends metformin as the default first-line medication for type 2 diabetes, recognizing that others may be more appropriate where there is a strong need to reduce cardiovascular and/or renal risk or lose weight.
Indeed, for young people, who have rapid progression of type 2 diabetes and a very high cardiovascular risk, upfront combination therapy may be considered, as in the VERIFY trial.
Conversely, the authors stress the need to consider frailty in older people, and the potential for adverse effects, which may point to the need to de-prescribe in this population.
Overall, pharmacologic management remains strongly guided by the individual needs of people with diabetes, such as reducing the risk for first or recurrent cardiovascular or renal events, controlling high glucose levels, or losing weight. Recently approved medications such as tirzepatide are now included as options for glucose-lowering and weight loss.
Co-lead author John Buse (University of North Carolina School of Medicine, Chapel Hill, USA) closed the session by highlighting remaining evidence gaps, including comparative studies of weight loss methods, and screening and prevention of diabetes in contemporary populations.
“We believe that empathic, person-centered decision-making and support informed by an understanding of local resources and individual social determinants of health is essential,” concluded Buse.
The slides presented in this conference session can be downloaded here.
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EASD Annual Meeting; Stockholm, Sweden: Sept 19–23, 2022
Diabetologia 2002; doi: 10.1007/s00125-022-05787-2
Diabetes Care 2022; doi:10.2337/dci22-0034