ADA recommends treating type 2 diabetes more aggressively

I could be snide and say, “Well, that only took a million years” or I could be thankful and say a lot of patients should now live longer with less complications.

In an article, “New Major Changes in Recommendations for the Treatment of Type 2 Diabetes by ADA and EASD” that appeared in DiabetesInControl, an online newsletter for health professionals, the ADA has issued new recommendations for treating type 2 diabetes more aggressively. 

What motivates the change appears to be the conclusion, “that much of the morbidity associated with long-term microvascular and neuropathic complications can be substantially reduced by interventions that achieve glucose levels close to the non-diabetic range. Although new classes of medications and numerous combinations have been demonstrated to lower glycemia, current-day management has failed to achieve and maintain the glycemic levels most likely to provide optimal healthcare status for people with diabetes.”

Translation: Yea, we got new medicines to keep blood sugar in control but most people’s blood sugar still isn’t in control. 

So new ADA health-care providers therapeutic recommendations are to speed the introduction of insulin:

Step 1 — Lifestyle intervention and use of metformin because of its effect on glycemia, absence of weight gain or hypoglycemia, good tolerability profile and relatively low cost. 

Step 2 — Add another medication, either insulin or a sulfonylurea, within 2 to 3 months of starting step 1 or at any time when target hemoglobin A1c level is not achieved or if metformin is contraindicated or poorly tolerated. For patients who have hemoglobin A1c level of more than 8.5% or symptoms secondary to hyperglycemia, insulin is preferred, typically a basal (intermediate- or long-acting) insulin. 

Step 3 — Further adjustments by starting or intensifying insulin therapy with additional injections that might include a short- or rapid-acting insulin given before selected meals to curtail postprandial hyperglycemia. 

David M. Nathan, MD, from the Diabetes Center of Massachusetts General Hospital in Boston says, “The epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can substantially reduce morbidity, have made the effective treatment of hyperglycemia a top priority.”  Hmmm…it wasn’t before? Oops, there goes my snide side. Hard for a type 1 to fathom the laxity in treating type 2 diabetes. “Maintaining glycemic levels as close to the non-diabetic range as possible,” continued Nathan, “has been demonstrated to have a powerful beneficial effect on diabetes-specific microvascular complications, including retinopathy, nephropathy, and neuropathy, in the setting of type 1 diabetes; in type 2 diabetes, more intensive treatment strategies have likewise been demonstrated to reduce microvascular complications.”

We can only hope physicians will know the new recommendations and patients will get effective treatment. If I were a type 2 I’d ask my health care provider for the best treatment to control my blood sugar to normal levels, whether it’s with a pill or a syringe. For most of us, it’ll mean more years on the planet and spending them happier and healthier.



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