This benefit has been demonstrated most clearly early in the natural history of the disease in studies using metformin, sulfonylureas, and insulin but is supported by more recent studies with other medication classes. Good glycemic management yields substantial and enduring reductions in onset and progression of microvascular complications. Beyond alleviating symptoms, the aim of blood glucose lowering (hereafter, referred to as glycemic management) is to reduce long-term complications of diabetes. Marked hyperglycemia is associated with symptoms including frequent urination, thirst, blurred vision, fatigue, and recurring infections. The Rationale, Importance, and Context of Glucose-Lowering Treatment Nevertheless, though evidence-based, the recommendations presented herein are the opinions of the authors. The draft consensus recommendations were peer reviewed (see “Acknowledgments”), and suggestions incorporated as deemed appropriate by the authors. Papers were grouped according to subject, and the authors reviewed this new evidence to inform the consensus recommendations. Details on the keywords and the search strategy are available at. Reference lists were scanned in eligible reports to identify additional articles relevant to the subject. To identify newer evidence, a search was conducted on PubMed for randomized clinical trials (RCTs), systematic reviews, and meta-analyses published in English between 1 January 2014 and 28 February 2018 eligible publications examined the effectiveness or safety of pharmacological or nonpharmacological interventions in adults with type 2 diabetes mellitus. The writing group accepted the 2012 ( 4) and 2015 ( 5) editions of this position statement as a starting point. GLP-1 receptor agonists are generally recommended as the first injectable medication. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is 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 those with obesity, efforts targeting weight loss, including lifestyle, medication, and surgical interventions, are recommended. These include additional focus on lifestyle management and diabetes self-management education and support. A systematic evaluation of the literature since 2014 informed new recommendations.
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The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 20, on the management of type 2 diabetes in adults.
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