![]() In this consensus report, we summarize a large body of recent evidence for practitioners in the U.S. These treatments were initially introduced as glucose-lowering agents but are now also prescribed for organ protection. These benefits are largely independent of their glucose-lowering effects. The demonstrated benefits for high-risk individuals with atherosclerotic cardiovascular disease (CVD), heart failure (HF), or chronic kidney disease (CKD) afforded by the glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium–glucose cotransporter 2 inhibitors (SGLT2i) provide important progress in treatment aimed at reducing the progression and burden of diabetes and its complications. The expanding number of glucose-lowering interventions-from behavioral interventions to pharmacological interventions, devices, and surgery-and growing information about their benefits and risks provide more options for people with diabetes and providers but complicate decision-making. This is often delivered in the context of diabetes self-management education and support (DSMES). The Rationale, Importance, and Context of Glucose-Lowering Treatmentįundamental aspects of diabetes care include promoting healthy behaviors through medical nutrition therapy (MNT), physical activity, and psychological support, as well as weight management and tobacco/substance abuse counseling as needed. Nevertheless, although evidence based with stakeholder input, the recommendations presented herein reflect the values and preferences of the consensus group. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. ![]() Evidence appraisal was informed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines on the formulation of clinical practice recommendations ( 9, 10). Up-to-date meta-analyses evaluating the effects of therapeutic interventions across clinically important subgroup populations were assessed in terms of their credibility using relevant guidance ( 7, 8). Papers were grouped according to subject, and the authors reviewed this new evidence. Details of the keywords and the search strategy are available at. Reference lists in eligible reports were scanned to identify additional relevant articles. To identify newer evidence, a search was conducted on PubMed for randomized control trials (RCTs), systematic reviews, and meta-analyses published in English between 28 January 2018 and 13 June 2022 eligible publications examined the effectiveness or safety of pharmacological or nonpharmacological interventions in adults with type 2 diabetes. The writing group accepted the 2012 ( 3), 2015 ( 4), 2018 ( 5), and 2019 ( 6) editions of this consensus report as a starting point. The group largely worked virtually, with regular teleconferences from September 2021, a 3-day workshop in January 2022, and a face-to-face 2-day meeting in April 2022. The writing group members were appointed by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD). After a summary listing of consensus recommendations, practical tips for implementation are provided. The results of cardiovascular and kidney outcomes trials involving sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, including assessment of subgroups, inform broader recommendations for cardiorenal protection in people with diabetes at high risk of cardiorenal disease. There is a greater emphasis on weight management as part of the holistic approach to diabetes management. These include additional focus on social determinants of health, the health care system, and physical activity behaviors, including sleep. ![]() A systematic examination of publications since 2018 informed new recommendations. The target audience is the full spectrum of the professional health care team providing diabetes care in the U.S. The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the previous consensus statements on the management of hyperglycemia in type 2 diabetes in adults, published since 2006 and last updated in 2019. ![]()
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