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Review
. 2022 Nov 1;45(11):2753-2786.
doi: 10.2337/dci22-0034.

Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Melanie J Davies  1   2 , Vanita R Aroda  3 , Billy S Collins  4 , Robert A Gabbay  5 , Jennifer Green  6 , Nisa M Maruthur  7 , Sylvia E Rosas  8 , Stefano Del Prato  9 , Chantal Mathieu  10 , Geltrude Mingrone  11   12   13 , Peter Rossing  14   15 , Tsvetalina Tankova  16 , Apostolos Tsapas  17   18 , John B Buse  19
Affiliations
Review

Management of Hyperglycemia in Type 2 Diabetes, 2022. 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. .

Abstract

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. The target audience is the full spectrum of the professional health care team providing diabetes care in the U.S. and Europe. A systematic examination of publications since 2018 informed new recommendations. These include additional focus on social determinants of health, the health care system, and physical activity behaviors, including sleep. There is a greater emphasis on weight management as part of the holistic approach to diabetes management. 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. After a summary listing of consensus recommendations, practical tips for implementation are provided.

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Conflict of interest statement

Duality of Interest. M.J.D. has acted as a consultant, advisory board member, and speaker for Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and Sanofi, an advisory board member and speaker for AstraZeneca, an advisory board member for Janssen, Lexicon, Pfizer, and ShouTi Pharma, and as a speaker for Napp Pharmaceuticals, Novartis, and Takeda Pharmaceuticals International. Her institution has received grants from Novo Nordisk, Sanofi, Eli Lilly, Boehringer Ingelheim, AstraZeneca, and Janssen. V.R.A. has served as a consultant for Applied Therapeutics, Duke, Fractyl, Novo Nordisk, Pfizer, and Sanofi. V.R.A.’s spouse is an employee of Janssen and a former employee of Merck. V.R.A.’s employer institution has received research funding for her role as investigator on clinical trials from Applied Therapeutics, Medpace, Eli Lilly, Fractyl, Premier, Novo Nordisk, and Sanofi. B.S.C. is a nominating work group member of the American Academy of Physician Assistants. R.A.G. is an advisor to Vida and Lark. J.G. is a consultant for AstraZeneca, Pfizer, Boehringer Ingelheim/Lilly, Bayer, Sanofi, Anji, Vertex/ICON, and Valo. She conducts research at her institution for Boehringer Ingelheim/Lilly, Merck, and Roche. N.M.M. is under a license agreement between Johns Hopkins HealthCare Solutions and Johns Hopkins University. She and the university are entitled to royalty distributions related to an online diabetes prevention program. S.E.R. participated in at least one advisory board for Bayer, Traverse, and AstraZeneca. Her employer receives industry research support from Bayer and Astra Zeneca. S.D.P. is a member of the advisory board for Abbott, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Hengrui Pharmaceuticals, Menarini International, Novo Nordisk, Sanofi, and Vertex. He is a participant in a speaker’s bureau for AstraZeneca, Boehringer Ingelheim, Eli Lilly, MSD, Novo Nordisk, Sanofi, and Takeda. His employer receives research funding from AstraZeneca and Boheringer Ingelheim. C.M. serves or has served on the advisory panel for Novo Nordisk, Sanofi, MSD, Eli Lilly, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, Medtronic, ActoBio Therapeutics, Pfizer, Insulet, and Zealand Pharma. Financial compensation for these activities has been received by KU Leuven. KU Leuven has received research support for C.M. from Medtronic, Novo Nordisk, Sanofi, and ActoBio Therapeutics. C.M. serves or has served on the speaker’s bureau for Novo Nordisk, Sanofi, Eli Lilly, Boehringer Ingelheim, AstraZeneca, and Novartis. Financial compensation for these activities has been received by KU Leuven. G.M. is a consultant to Novo Nordisk, Fractyl, Recor, Keyron, and Metadeq and is on the scientific board of Fractyl. P.R.’s institution has received industry research funding from AstraZeneca and Novo Nordisk. Her institution has also received consultancy fees from AstraZeneca, Bayer, Boehringer Ingelheim, Novo Nordisk, Gilead, and MSD and lecture fees from Sanofi, Astellas, Novo Nordisk, Bayer, and AstraZeneca. T.T. is on the advisory board for Boehringer Ingelheim, AstraZeneca, Sanofi, Novo Nordisk, and Eli Lilly and in the speaker’s bureau for Boehringer Ingelheim, AstraZeneca, Sanofi, Novo Nordisk, Eli Lilly, MSD, Servier, and Merck. A.T. has served on the advisory board for Novo Nordisk and Boehringer Ingelheim, and his university has received research funding. His university also receives funding for educational and research support from Eli Lilly. J.B.B. is a paid consultant to Anji Pharmaceuticals, Boehringer Ingelheim, Eli Lilly, Fortress Biotech, Janssen, Mellitus Health, Moderna, Pendulum Therapeutics, Praetego, ReachMD, Stability Health, and Zealand Pharma. He is a member of the advisory board for Boehringer Ingelheim, Eli Lilly, Mellitus Health, Moderna, Novo Nordisk, Pendulum Therapeutics, Praetego, Stability Health, vTv Therapeutics, and Zealand Pharma. His employer receives research funding from Dexcom, Eli Lilly, NovaTarg, Novo Nordisk, Sanofi, Tolerion, and vTv Therapeutics. He is an investor in Mellitus Health, Pendulum Therapeutics, and PhaseBio.

Figures

None
Graphical abstract
Figure 1
Figure 1
Decision cycle for person-centered glycemic management in type 2 diabetes. Adapted from Davies et al. (5) with permission. BGM, blood glucose monitoring; BP, blood pressure; CGM, continuous glucose monitoring; CKD, chronic kidney disease; CVD, atherosclerotic cardiovascular disease; DSMES, diabetes self-management education and support; HF, heart failure.
Figure 2
Figure 2
Importance of 24-h physical behaviors for type 2 diabetes.
Figure 3
Figure 3
Use of glucose-lowering medications in the management of type 2 diabetes. ACEi, angiotensin-converting enzyme inhibitor; ACR, albumin/creatinine ratio; ARB, angiotensin receptor blocker; ASCVD, atherosclerotic cardiovascular disease; CGM, continuous glucose monitoring; CKD, chronic kidney disease; CV, cardiovascular; CVD, cardiovascular disease; CVOT, cardiovascular outcomes trial; DPP-4i, dipeptidyl peptidase 4 inhibitor; eGFR, estimated glomerular filtration rate; GLP-1 RA, glucagon-like peptide 1 receptor agonist; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HHF, hospitalization for heart failure; MACE, major adverse cardiovascular events; MI, myocardial infarction; SDOH, social determinants of health; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T2D, type 2 diabetes; TZD, thiazolidinedione.
Figure 4
Figure 4
Holistic person-centered approach to T2DM management. 1“Cardiovascular Disease and Risk Management” in Standards of Medical Care in Diabetes—2022 (141). ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blockers; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CKD, chronic kidney disease; CV, cardiovascular; eGFR, estimated glomerular filtration rate; GLP-1 RA, glucagon-like peptide 1 receptor agonist; HF, heart failure; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T2D, type 2 diabetes.
Figure 5
Figure 5
Place of insulin. *NPH insulin or preferably analog to reduce nocturnal hypoglycemia risk. 1More details can be found in Davies et al. (12) and “Pharmacologic Approaches to Glycemic Treatment” in Standards of Medical Care in Diabetes—2022 (16). CGM, continuous glucose monitoring; DSMES, diabetes self-management education and support; FPG, fasting plasma glucose; GLP-1 RA, glucagon-like peptide 1 receptor agonist; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T1D, type 1 diabetes; TIR, time in range.
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