Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Practice Guideline
. 2018 Dec;41(12):2669-2701.
doi: 10.2337/dci18-0033. Epub 2018 Oct 4.

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)

Melanie J Davies  1   2 , David A D'Alessio  3 , Judith Fradkin  4 , Walter N Kernan  5 , Chantal Mathieu  6 , Geltrude Mingrone  7   8 , Peter Rossing  9   10 , Apostolos Tsapas  11 , Deborah J Wexler  12   13 , John B Buse  14
Affiliations
Practice Guideline

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)

Melanie J Davies et al. Diabetes Care. 2018 Dec.

Abstract

The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication, and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Decision cycle for patient-centered glycemic management in type 2 diabetes.
Figure 2
Figure 2
Glucose-lowering medication in type 2 diabetes: overall approach. CV, cardiovascular; DPP-4i, dipeptidyl peptidase 4 inhibitor; GLP-1 RA, glucagon-like peptide 1 receptor agonist; SGLT2i, SGLT2 inhibitor; SU, sulfonylurea.
Figure 3
Figure 3
Choosing glucose-lowering medication in those with established ASCVD, HF, and CKD. CV, cardiovascular; DPP-4i, dipeptidyl peptidase 4 inhibitor; GLP-1 RA, glucagon-like peptide 1 receptor agonist; SGLT2i, SGLT2 inhibitor; SU, sulfonylurea.
Figure 4
Figure 4
Choosing glucose-lowering medication if compelling need to minimize weight gain or promote weight loss. GLP-1 RA, glucagon-like peptide 1 receptor agonist; T2DM, type 2 diabetes; SGLT2i, SGLT2 inhibitor; SU, sulfonylurea.
Figure 5
Figure 5
Choosing glucose-lowering medication if compelling need to minimize hypoglycemia. DPP-4i, dipeptidyl peptidase 4 inhibitor; GLP-1 RA, glucagon-like peptide 1 receptor agonist; SGLT2i, SGLT2 inhibitor.
Figure 6
Figure 6
Choosing glucose-lowering medication if cost is a major issue. DPP-4i, dipeptidyl peptidase 4 inhibitor; SGLT2i, SGLT2 inhibitor; SU, sulfonylurea.
Figure 7
Figure 7
Intensifying to injectable therapies. FRC, fixed-ratio combination; GLP-1 RA, glucagon-like peptide 1 receptor agonist; FBG, fasting blood glucose; FPG, fasting plasma glucose; max, maximum; PPG, postprandial glucose.
Figure 8
Figure 8
Considering oral therapy in combination with injectable therapies. DKA, diabetic ketoacidosis; DPP-4i, dipeptidyl peptidase 4 inhibitor; GLP-1 RA, glucagon-like peptide 1 receptor agonist; SGLT2i, SGLT2 inhibitor; SU, sulfonylurea.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Rodriguez-Gutierrez R, Gionfriddo MR, Ospina NS, et al. . Shared decision making in endocrinology: present and future directions. Lancet Diabetes Endocrinol 2016;4:706–716 - PubMed
    1. American Diabetes Association 6. Glycemic targets: Standards of Medical Care in Diabetes—2018. Diabetes Care 2018;41(Suppl. 1):S55–S64 - PubMed
    1. American Diabetes Association 8. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes—2018. Diabetes Care 2018;41(Suppl. 1):S73–S85 - PubMed
    1. Inzucchi SE, Bergenstal RM, Buse JB, et al. .; Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) . Management of hyperglycaemia in type 2 diabetes a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012;55:1577–1596 - PubMed
    1. Inzucchi SE, Bergenstal RM, Buse JB, et al. . Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2015;58:429–442 - PubMed

Publication types

Substances