EASD 2022: Management of Hyperglycaemia in Type 2 Diabetes: ADA/EASD Consensus Report 2022

The presentation focuses on the management of hyperglycaemia, implementation of guidelines and evidence obtained in the last 3 years, a holistic approach in management and importance of weight goals.

The main goal of diabetes care is to prevent complications for improving overall health and promoting quality of life. While managing this, it is important to prescribe medication with cardio renal protective properties, promote weight management and mediate any cardiovascular risk factors that may be present.

Weight loss is associated with a disease modifying effect as well as remission of disease. The benefits of weight loss not only include managing glycaemia but also an improvement in cardiovascular risk factors and overall quality of life. While offering goals of care to a patient, it is important to consider factors that impact choice of treatment such as complexity of regimen costs. The diabetes management plan should also focus on self-management, education and support and shared decision making.

In management of obesity, Semaglutide 2.4mg once weekly produces a weight loss of 9.6%; novel GIP/GLP1 agonist Tirzepatide produces a weight loss of 19.5% at 10mg dose and 20.9% at 15mg weekly dose. Metabolic surgery can produce weight loss upto 30% and can help achieve glycaemic control for a long time. In order to achieve weight reduction, it is important to consider lifestyle changes, medical nutrition therapy, physical activity, anti-obesity medication and metabolic surgery while choosing a glucose lowering therapy.

Sleep disorders are common T2D and are associated with poor outcomes, an increased risk of obesity and impairments in daytime functioning and glucose control.

Among glucose lowering medications, SGLT2i and GLP1 agonists have shown effective glucose lowering with cardiorenal protective properties. GLP1 agonists have a high glucose lowering efficacy with low risk of hypoglycaemia and intermediate to high weight loss depending on the agent that they are assessed to be. Insulins have high glucose lowering ability; although, they may be associated with an increased risk of hypoglycaemia and weight gain with a neutral cardiorenal profile. In patients with heart failure, CKD, established CVD or multiple risk factors for CVD, the decision to choose SGLT2i or GLP-RA should be independent of background metformin use or baseline HbA1c.

In patients with CKD, SGLT2i and GLP1-RA reduce risk of MACE, HF and kidney outcomes.

The selection of medications to improve cardiovascular and kidney outcomes should not differ for older people. However, not prescribing unnecessary medications, reducing medication burden, and reducing the potential for side effects such as hypoglycemia or hypertension should be taken into account. In the young population, early use of combination therapy to manage hypoglycemia should be considered.

The gaps in managing patients with T2D include, person-centered decision making, efforts required to improve health behaviors, acceptance, adherence of patients to medical interventions and the implementation of evidence-based interventions.

In summary, managing diabetes should have a holistic approach which includes appropriate monitoring, cardiorenal protection, reducing the risk of hypoglycaemia, blood pressure and lipid lowering and having structured diabetes education.