2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the...

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Published in	Diabetes care Vol. 43; no. 2; pp. 487 - 493
Main Authors	Buse, John B., Wexler, Deborah J., Tsapas, Apostolos, Rossing, Peter, Mingrone, Geltrude, Mathieu, Chantal, D’Alessio, David A., Davies, Melanie J.
Format	Journal Article
Language	English
Published	United States American Diabetes Association 01.02.2020
Subjects	Agonists Albumins Cardiovascular diseases Cardiovascular Diseases - blood Cardiovascular Diseases - prevention & control Clinical trials Consensus Consensus Report Update Creatinine Death Diabetes Diabetes Complications - blood Diabetes Complications - drug therapy Diabetes Complications - prevention & control Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - therapy Ejection fraction Europe Glomerular filtration rate GLP-1 receptor agonists Glucagon Glucagon-like peptide 1 Health risk assessment Heart diseases Heart failure History, 21st Century Humans Hyperglycemia Hyperglycemia - blood Hyperglycemia - etiology Hyperglycemia - therapy Hypoglycemic Agents - classification Hypoglycemic Agents - therapeutic use Kidney diseases Male Mortality Renal Insufficiency, Chronic - blood Renal Insufficiency, Chronic - drug therapy Societies, Medical - organization & administration Societies, Medical - standards Sodium-glucose cotransporter Sodium-Glucose Transporter 2 Inhibitors - therapeutic use United States United States Europe
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Abstract	The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium–glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target; 2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min–1 [1.73 m]–2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death.
AbstractList	The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium–glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target; 2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min–1 [1.73 m]–2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death. The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1 ) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium–glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA 1c or individualized HbA 1c target; 2 ) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3 ) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min –1 [1.73 m] –2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death. The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: ) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium-glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA or individualized HbA target; ) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and ) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min [1.73 m] or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death. The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium-glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target; 2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min-1 [1.73 m]-2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death.The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium-glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target; 2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min-1 [1.73 m]-2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death.
Author	Buse, John B. Tsapas, Apostolos Wexler, Deborah J. D’Alessio, David A. Mingrone, Geltrude Mathieu, Chantal Davies, Melanie J. Rossing, Peter
Author_xml	– sequence: 1 givenname: John B. orcidid: 0000-0002-9723-3876 surname: Buse fullname: Buse, John B. organization: Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC – sequence: 2 givenname: Deborah J. orcidid: 0000-0001-6979-402X surname: Wexler fullname: Wexler, Deborah J. organization: Department of Medicine and Diabetes Unit, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA – sequence: 3 givenname: Apostolos orcidid: 0000-0003-0221-4072 surname: Tsapas fullname: Tsapas, Apostolos organization: Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece – sequence: 4 givenname: Peter surname: Rossing fullname: Rossing, Peter organization: Steno Diabetes Center Copenhagen, Gentofte, Denmark, University of Copenhagen, Copenhagen, Denmark – sequence: 5 givenname: Geltrude orcidid: 0000-0003-2021-528X surname: Mingrone fullname: Mingrone, Geltrude organization: Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, Università Cattolica del Sacro Cuore, Rome, Italy, Diabetes and Nutritional Sciences, King's College London, London, U.K – sequence: 6 givenname: Chantal orcidid: 0000-0002-6099-2406 surname: Mathieu fullname: Mathieu, Chantal organization: Clinical and Experimental Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium – sequence: 7 givenname: David A. surname: D’Alessio fullname: D’Alessio, David A. organization: Department of Medicine, Duke University School of Medicine, Durham, NC – sequence: 8 givenname: Melanie J. surname: Davies fullname: Davies, Melanie J. organization: Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/31857443$$D View this record in MEDLINE/PubMed
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Cites_doi	10.1056/NEJMoa1811744 10.1016/S2213-8587(19)30066-X 10.1161/CIRCULATIONAHA.118.035759 10.1056/NEJMoa1901118 10.1016/S0140-6736(19)31149-3 10.1161/CIRCULATIONAHA.119.040130 10.1007/s00125-018-4729-5 10.1161/CIRCULATIONAHA.118.038868 10.1111/dom.13847 10.1001/jama.2018.18269 10.2337/dci18-0033 10.1161/CIRCULATIONAHA.119.042007 10.1016/S2213-8587(16)30267-4 10.1056/NEJMoa1812389 10.1161/CIRCULATIONAHA.119.040057 10.1016/S0140-6736(19)32131-2 10.1016/S2213-8587(18)30023-8 10.1016/S2213-8587(19)30249-9
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References	Davies (2022031300174170200_B2) 2018; 61 Kato (2022031300174170200_B6) 2019; 139 Inzucchi (2022031300174170200_B9) 2018; 138 Zinman (2022031300174170200_B18) 2019; 7 Wiviott (2022031300174170200_B4) 2019; 380 Davies (2022031300174170200_B1) 2018; 41 Giugliano (2022031300174170200_B13) 2019; 21 Matthews (2022031300174170200_B17) 2019; 394 Frías (2022031300174170200_B20) 2016; 4 Rosenstock (2022031300174170200_B16) 2019; 321 McMurray (2022031300174170200_B8) Gerstein (2022031300174170200_B3) 2019; 394 Kristensen (2022031300174170200_B14) 2019; 7 Rosenstock (2022031300174170200_B15) Zelniker (2022031300174170200_B5) 2019; 139 Perkovic (2022031300174170200_B10) 2019; 380 Mahaffey (2022031300174170200_B11) 2019; 140 Ludvik (2022031300174170200_B19) 2018; 6 Figtree (2022031300174170200_B7) 2019; 139 Husain (2022031300174170200_B12) 2019; 381 32444453 - Diabetes Care. 2020 Jul;43(7):1670. doi: 10.2337/dc20-er07
References_xml	– volume: 380 start-page: 2295 year: 2019 ident: 2022031300174170200_B10 article-title: Canagliflozin and renal outcomes in type 2 diabetes and nephropathy publication-title: N Engl J Med doi: 10.1056/NEJMoa1811744 – ident: 2022031300174170200_B15 article-title: Effect of linagliptin vs glimepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes: the CAROLINA randomized clinical trial publication-title: JAMA – volume: 7 start-page: 356 year: 2019 ident: 2022031300174170200_B18 article-title: Semaglutide once weekly as add-on to SGLT-2 inhibitor therapy in type 2 diabetes (SUSTAIN 9): a randomised, placebo-controlled trial publication-title: Lancet Diabetes Endocrinol doi: 10.1016/S2213-8587(19)30066-X – volume: 138 start-page: 1904 year: 2018 ident: 2022031300174170200_B9 article-title: Improvement in cardiovascular outcomes with empagliflozin is independent of glycemic control publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.118.035759 – volume: 381 start-page: 841 year: 2019 ident: 2022031300174170200_B12 article-title: Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes publication-title: N Engl J Med doi: 10.1056/NEJMoa1901118 – ident: 2022031300174170200_B8 article-title: Dapagliflozin in patients with heart failure and reduced ejection fraction publication-title: N Engl J Med – volume: 394 start-page: 121 year: 2019 ident: 2022031300174170200_B3 article-title: Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial publication-title: Lancet doi: 10.1016/S0140-6736(19)31149-3 – volume: 139 start-page: 2528 year: 2019 ident: 2022031300174170200_B6 article-title: Effect of dapagliflozin on heart failure and mortality in type 2 diabetes mellitus publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.119.040130 – volume: 61 start-page: 2461 year: 2018 ident: 2022031300174170200_B2 article-title: Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) publication-title: Diabetologia doi: 10.1007/s00125-018-4729-5 – volume: 139 start-page: 2022 year: 2019 ident: 2022031300174170200_B5 article-title: Comparison of the effects of glucagon-like peptide receptor agonists and sodium-glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in type 2 diabetes mellitus publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.118.038868 – volume: 21 start-page: 2576 year: 2019 ident: 2022031300174170200_B13 article-title: GLP-1 receptor agonists for prevention of cardiorenal outcomes in type 2 diabetes: an updated meta-analysis including the REWIND and PIONEER 6 trials publication-title: Diabetes Obes Metab doi: 10.1111/dom.13847 – volume: 321 start-page: 69 year: 2019 ident: 2022031300174170200_B16 article-title: Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk: the CARMELINA randomized clinical trial publication-title: JAMA doi: 10.1001/jama.2018.18269 – volume: 41 start-page: 2669 year: 2018 ident: 2022031300174170200_B1 article-title: Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) publication-title: Diabetes Care doi: 10.2337/dci18-0033 – volume: 140 start-page: 739 year: 2019 ident: 2022031300174170200_B11 article-title: Canagliflozin and cardiovascular and renal outcomes in type 2 diabetes mellitus and chronic kidney disease in primary and secondary cardiovascular prevention groups publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.119.042007 – volume: 4 start-page: 1004 year: 2016 ident: 2022031300174170200_B20 article-title: Exenatide once weekly plus dapagliflozin once daily versus exenatide or dapagliflozin alone in patients with type 2 diabetes inadequately controlled with metformin monotherapy (DURATION-8): a 28 week, multicentre, double-blind, phase 3, randomised controlled trial publication-title: Lancet Diabetes Endocrinol doi: 10.1016/S2213-8587(16)30267-4 – volume: 380 start-page: 347 year: 2019 ident: 2022031300174170200_B4 article-title: Dapagliflozin and cardiovascular outcomes in type 2 diabetes publication-title: N Engl J Med doi: 10.1056/NEJMoa1812389 – volume: 139 start-page: 2591 year: 2019 ident: 2022031300174170200_B7 article-title: Effects of canagliflozin on heart failure outcomes associated with preserved and reduced ejection fraction in type 2 diabetes mellitus publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.119.040057 – volume: 394 start-page: 1519 year: 2019 ident: 2022031300174170200_B17 article-title: Glycaemic durability of an early combination therapy with vildagliptin and metformin versus sequential metformin monotherapy in newly diagnosed type 2 diabetes (VERIFY): a 5-year, multicentre, randomised, double-blind trial publication-title: Lancet doi: 10.1016/S0140-6736(19)32131-2 – volume: 6 start-page: 370 year: 2018 ident: 2022031300174170200_B19 article-title: Dulaglutide as add-on therapy to SGLT2 inhibitors in patients with inadequately controlled type 2 diabetes (AWARD-10): a 24-week, randomised, double-blind, placebo-controlled trial publication-title: Lancet Diabetes Endocrinol doi: 10.1016/S2213-8587(18)30023-8 – volume: 7 start-page: 776 year: 2019 ident: 2022031300174170200_B14 article-title: Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials publication-title: Lancet Diabetes Endocrinol doi: 10.1016/S2213-8587(19)30249-9 – reference: 32444453 - Diabetes Care. 2020 Jul;43(7):1670. doi: 10.2337/dc20-er07
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SubjectTerms	Agonists Albumins Cardiovascular diseases Cardiovascular Diseases - blood Cardiovascular Diseases - prevention & control Clinical trials Consensus Consensus Report Update Creatinine Death Diabetes Diabetes Complications - blood Diabetes Complications - drug therapy Diabetes Complications - prevention & control Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - therapy Ejection fraction Europe Glomerular filtration rate GLP-1 receptor agonists Glucagon Glucagon-like peptide 1 Health risk assessment Heart diseases Heart failure History, 21st Century Humans Hyperglycemia Hyperglycemia - blood Hyperglycemia - etiology Hyperglycemia - therapy Hypoglycemic Agents - classification Hypoglycemic Agents - therapeutic use Kidney diseases Male Mortality Renal Insufficiency, Chronic - blood Renal Insufficiency, Chronic - drug therapy Societies, Medical - organization & administration Societies, Medical - standards Sodium-glucose cotransporter Sodium-Glucose Transporter 2 Inhibitors - therapeutic use United States
Title	2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
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