A new joint position statement released this summer by the American Diabetes Association and the European Association for the Study of Diabetes, and published in the journal Diabetes Care titled Management of Hyperglycemia in Type2 Diabetes: A Patient-Centered Approach, promotes a more flexible approach to blood sugar control. Citing undesirable side effects of some diabetes medications, including weight gain and hypoglycemia (low blood sugar), the organizations suggest that not all patients should be pushed toward tight blood sugar control.
Here’s the summary of the position statement:
- Glycemic targets and glucose-lowering therapies must be individualized.
- Diet, exercise, and education remain the foundation of any type 2 diabetes treatment program.
- Unless there are prevalent contraindications, metformin is the optimal first-line drug.
- After metformin, there are limited data to guide us. Combination therapy with an additional 1–2 oral or injectable agents is reasonable, aiming to minimize side effects where possible.
- Ultimately, many patients will require insulin therapy alone or in combination with other agents to maintain glucose control.
- All treatment decisions, where possible, should be made in conjunction with the patient, focusing on his/her preferences, needs, and values.
- Comprehensive cardiovascular risk reduction must be a major focus of therapy.
The position is not universally accepted. Some diabetes specialists insist that aggressive treatment, especially at diagnosis, can maintain natural insulin secreting function longer, delaying the necessity for multiple oral medications and/or insulin injections.