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.
Presenting the new consensus statement at EASD’s 58th Annual Meeting in Stockholm, Sweden, ADA Scientific and Medical Director Robert Gabbay described this iteration as “perhaps the best yet.” .
Co-lead author Melanie Davies (University of Leicester, UK) said the team had a particular focus on the social determinants of health, the health system, holistic person-centred care, quality of care and weight management” as an essential component of comprehensive care.
The social determinants identified include socio-economic status, living and working conditions, multi-sectoral domains (such as housing and education), socio-cultural context, and socio-political context, such as societal and political ideologies and policies that may underlie health disparities.
The report also highlights the importance of appropriate language, which should be neutral, factual and free from stigma, and encourage collaborative person-centred care.
Holistic care includes cardiorenal protection, cardiovascular risk factor management, weight management, and blood sugar management, all of which are equally important. Therapeutic inertia is addressed and hepatic complications make their first appearance.
The authors also highlight the importance for people with type 2 diabetes to address physical behaviors throughout the day and night, including discontinuing prolonged sitting, increasing step counts, and undertake resistance training in addition to aerobic exercise. Another newly integrated element is sleep – both qualitative and quantitative – in which people’s natural chronotypes must be taken into account.
Additionally, the updated report includes “a consolidation of evidence from outcome studies,” Davies said. 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, acknowledging that others may be more appropriate when there is a strong need to reduce cardiovascular risk and/or kidney or lose weight.
Indeed, for young people, who have a rapid progression of type 2 diabetes and a very high cardiovascular risk, an upstream combination therapy can be considered, as in the VERIFY trial.
Conversely, the authors insist on the need to take into account frailty in the elderly and the potential for adverse effects, which may indicate the need for deprescribing in this population.
Overall, pharmacological management remains strongly guided by the individual needs of people with diabetes, such as reducing the risk of primary or recurrent cardiovascular or renal events, controlling high blood sugar, or weight loss. . Recently approved drugs such as tirzepatide are now included as options for blood sugar reduction and weight loss.
Co-lead author John Buse (University of North Carolina School of Medicine, Chapel Hill, USA) closed the session by highlighting the remaining evidence gaps, including comparative studies of loss methods weight, as well as the screening and prevention of diabetes in contemporary populations.
“We believe that empathetic, person-centered decision-making and support, informed by an understanding of local resources and individual social determinants of health, is essential,” Buse concluded.
The slides presented in this conference session can be downloaded here.
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EASD annual meeting; Stockholm, Sweden: September 19-23, 2022
Diabetology 2002; doi: 10.1007/s00125-022-05787-2
Diabetic treatments 2022; doi:10.2337/dci22-0034