Management of Hyperglycemia 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)

Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA.
Diabetes care (Impact Factor: 8.57). 04/2012; 35(6):1364-79. DOI: 10.2337/dc12-0413
Source: PubMed
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Available from: Apostolos Tsapas, Aug 29, 2015
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    • "One strategy initiated insulin therapy with one injection a day of the basal insulin, insulin glargine, and added one injection of insulin glulisine, a rapid-acting insulin before the main meal if glycemic control was insufficient. This strategy (basal-plus) is a recommended second step when basal insulin is insufficient to achieve the therapeutic goal (Handelsman et al., 2011; International Diabetes Federation: IDF Clinical Guidelines Task Force, 2012; Inzucchi et al., 2012). The other strategy initiated insulin therapy with one or two injections of premixed insulin as needed. "
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    • "Evidence-based literature focusing on hyperglycemic emergencies associated with DM was also reviewed using major databases. Existing protocols from the literature were used to evaluate the EHR for adherence to the most contemporary evidence related to the diagnosis and treatment of HHNKS (Inzucchi et al., 2012; Kitabchi et al., 2008 "
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    • "Metformin is recommended as first-line treatment for type 2 diabetes (T2D) after diet and exercise [1] [2] [3] [4] [5] [6]. Most patients require treatment intensification over time, but subsequent treatment options remain uncertain, partially due to the lack of well-designed head-to-head randomized controlled trials of sequenced treatments [7]. "
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    ABSTRACT: AimsThe EUREXA trial extension evaluated third-line thiazolidinedione or glimepiride therapy in patients inadequately controlled on metformin + exenatide twice daily (BID), and third-line exenatide BID in patients inadequately controlled on metformin + glimepiride.Materials and methodsIn this randomized, open-label, multicenter trial, 144 patients with type 2 diabetes inadequately controlled (glycated hemoglobin [HbA1c] >9% [75 mmol/mol] after 3 months’ treatment or >7% [53 mmol/mol] at 2 consecutive visits 3 months apart after 6 months’ treatment) on metformin + exenatide BID were re-randomized to add-on thiazolidinedione or glimepiride, and 166 patients inadequately controlled on metformin + glimepiride received add-on exenatide BID. Changes in HbA1c, body mass index (BMI), lipids, hypoglycemia, and vital signs were evaluated.ResultsMedian triple therapy duration was ~2 years. In patients inadequately controlled on metformin + exenatide BID, add-on thiazolidinedione decreased HbA1c significantly better than add-on glimepiride (130-week difference 0.48%, 95% CI 0.19–0.77 [5.2 mmol/mol, 2.1–8.4], p = 0.001), but with significantly increased BMI and systolic blood pressure. Ratio of documented symptomatic (blood glucose ≤70 mg/dl) hypoglycemia rates for add-on glimepiride to add-on thiazolidinedione was 8.48 (p < 0.0001). Add-on exenatide BID after metformin + glimepiride significantly reduced HbA1c (mean [SD] change from baseline −0.35 [0.89]% [−3.8 (9.7) mmol/mol]) and BMI (−0.82 [1.9] kg/m2) at 130 weeks, with a slightly increased rate of documented symptomatic hypoglycemia from metformin + glimepiride (ratio 1.49).Conclusions Thiazolidinedione, but not glimepiride, was an effective and well tolerated third-line therapy in patients without glycemic control after long-term therapy with metformin + exenatide BID. Exenatide BID was an effective and well tolerated third-line therapy in patients inadequately controlled on metformin + glimepiride.(NCT00359762)
    Diabetes Obesity and Metabolism 04/2015; 17(7). DOI:10.1111/dom.12471 · 5.46 Impact Factor
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