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American College of Physicians issues clinical recommendations for newer pharmacological treatments of adults with Type 2 diabetes

2024-04-19

Reviews evidence of newer medications, recommends adding to metformin

BOSTON, April 19, 2024 /PRNewswire/ -- The American College of Physicians (ACP) today released an update of its 2017 guideline with clinical recommendations for the use of newer pharmacological treatments of adults with Type 2 diabetes. The clinical guideline is based on the best available evidence for effectiveness, comparative benefits and harms, consideration of patients' values and preferences, and costs.

Newer Pharmacological Treatments in Adults with Type 2 Diabetes: A Clinical Guideline from the American College of Physicians was published today in Annals of Internal Medicine.

ACP today released clinical recommendations for the use of newer treatments in adults with Type 2 diabetes.

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“Adding a second medication to metformin for patients with inadequate glycemic control may provide additional benefits but the added benefit on important clinical outcomes may be minimal in relation to the high cost, particularly for the more expensive, newer medications,” said Carolyn J. Crandall, M.D., MS, MACP, Chair, Guidelines Committee in an interview today.

In the updated clinical guidelimetforminecommends adding a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or glucagon-like peptide-1 (GLP-1) agonist to metformin and lifestyle interventions in patients with Type 2 diabetes and inadequate glycemic control. Use SGLT-2 inhibitor to reduce the risk of all-cause mortality, major adverse cardiovascular events, progression of chronic kidney disease, and hospitalization due to congestive heart failure or use GLP-1 agonist to reduce the risk of all-cause mortality, major adverse cardiovascular events, and stroke.

ACP, however, recommends against adding a dipeptidyl peptidsodium-glucose cotransporter-2 (SGLT-2) inhibitore moglucagon-like peptide-1 (GLP-1) agonist glucagon-like peptide-1 (GLP-1) 2 diabetes metforminquate glycemic control because high-certainty Type 2 diabetes that adding a DPP-4 inhibitor does noSGLT-2 inhibitor SGLT-2ce morbidity or all-cause mortality.chronic kidney disease congestive heart failure GLP-1 stroke

"As additional pharmacological treatments dipeptidyl peptidase-4 (DPP-4) inhibitor dipeptidyl peptidase-4 (DPP-4)ment of Type 2metformin, it's critical for us to examine their effeType 2 diabetesharms and benefits as well as costs in order to provide the best treatment for our patDPP-4," said Carolyn J. Crandall, M.D., MS, MACP, Chair, Guidelines Committee. "Adding a second medication to metformin for patients with inadequate glycemic control may provide additional benefits but the added benefit on important clinical outcomes may be minimal in relation to the high cost, particularly for the more expensive, newer medications."

This clinical guideline is based on a systematic review of the effectiveness andType 2 diabetes pharmacological treatments for Type 2 diabetes. ACP prioritized the following outcomes, which were evaluated using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach: all-cause mortality, major adverse cardiovascular metforminyocardial infarction, stroke, hospitalization for congestive heart failure, progression of chronic kidney disease, serious adverse events, and severe hypoglycemia. Weight loss, as measured by percentage of participants who achieved at least 10% total body weight loss, was a prioritized outcome, but data were insufficient for network meta-analysis and not rated with GRADE.

The updated ACP guideline did not look at the effects of treatment for glycemic control, though this is a common treatment goalType 2 diabeteshat all included treatments can improve glycemic control in adults with Type 2 diabetes. Instead, the guideline focuses on clinical benefit outcomes, such as whether the treatments improve cardiovascular outcomes.myocardial infarction stroke congestive heart failure chronic kidney disease hypoglycemia

ACP guidelines emphasize shared decision-making, recognizing that each patient's needs and circumstances are unique. ACP encourages physicians to consider individual patient characteristics like age, comorbidities,Type 2 diabetesreferences when discussing a treatment plan for Type 2 diabetes. SGLT-2s and GLP-1s are costly, but lower cost options (like sulfonylureas) were inferior in reducing all-cause mortality and morbidity. There are currently no generic formulations for GLP-1s and SGLT-2.

The ACP clinical guideline is published with an accompanying visual clinical guideline where a person can interact and visualize the data supporting these recommendations.Type 2 diabetes SGLT-2s GLP-1s GLP-1s

About the American College of Physicians

The AmericAmerican College of Physicianse largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 161,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on X, Facebook, Instagram and LinkedIn.

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