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Type 2 treatment intensification guidelines issued

By Editor
6th September 2018
Care planning, Clinical guidance Type 1 diabetes Type 2 diabetes

Guidelines about treatment intensification in adults with type 2 diabetes have been issued for healthcare professionals around the world.

The recommendations, which appeared in Annals of Internal Medicine, were published by the World Health Organization (WHO) and also featured information about analogue or human insulin in type 1 and 2 diabetes.

They were drafted by WHO’s Dr Gojka Roglic, and Dr Susan L. Norris, who wrote: “The guidelines had two objectives. The first was to consider the use of dipeptidyl peptidase-4 inhibitors, sodium–glucose cotransporter-2 inhibitors, thiazolidinediones, and insulin as second- and third-line treatment for control of Hyperglycaemia in non-pregnant adults with type 2 diabetes after failure of metformin and sulfonylureas. Glucagonlike peptide-1 analogues were not considered because they are infrequently available in low-income countries.

“The second objective was to provide guidance on use of insulin analogues for type 1 and 2 diabetes. Only insulin analogues for which trial comparisons with human insulin were available were considered.”

The recommendations stated:

  • Prescribe a sulfonylurea to patients with type 2 diabetes who have contraindications to metformin or do not reach glycemic control with metformin alone.
  • Introduce human insulin treatment to patients with type 2 diabetes who do not reach glycemic control with a sulfonylurea and/or metformin.
  • If insulin is unsuitable, a thiazolidinedione, or a sodium–glucose cotransporter-2 inhibitor or a dipeptidyl peptidase-4 inhibitor may also be included.
  • Utilise human insulin to manage blood glucose in adults with type 1 diabetes and in adults with type 2 diabetes for whom insulin is indicated.
  • Contemplate long-acting insulin analogues to manage blood glucose in adults with type 1 or type 2 diabetes who often have severe hypoglycemia with human insulin.

To read the recommendations, click here.

Comments (1)

  1. Peter Palmer says:

    Why, for T2DM patients, is there no mention of diet?
    If diet is modified away from fad low fat, high carb diet the diabetes comes under control….no carbs = no dietary glucose = no hyperglycaemia.
    Drugs do nothing to treat the cause, only the symptoms and are ultimately harmful.

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