WHO released recommendations regarding which medicines should be used for treatment intensification in adult patients with type 2 diabetes as well as the use of analogue or human insulin in type 1 and 2 diabetes.
â€śThe guidelines had two objectives. The first was to consider the use of dipeptidyl peptidase-4 inhibitors, sodiumâ€“glucose cotransporter-2 inhibitors, thiazolidinediones, and insulin as second- and third-line treatment for control of hyperglycemia in nonpregnant adults with type 2 diabetes after failure of metformin and sulfonylureas. Glucagonlike peptide-1 analogues were not considered because they are infrequently available in low-income countries,â€ť Gojka Roglic, MD, MSc, and Susan L. Norris, MD, MPH, of WHO wrote.
â€śThe second objective was to provide guidance on use of insulin analogues for type 1 and 2 diabetes. Only insulin analogues for which trial comparisons with human insulin were available were considered,â€ť they continued.
The recommendations, which appeared in Annals of Internal Medicine, state:
Linda L. Humphrey, MD, MPH
of the High Value Care Committee of the ACP and colleagues pointed out the major differences between the ACP and WHO guidelines in a related editorial.
â€śFor its guideline, the WHO group ranked glycemic control, an intermediate outcome as opposed to a health outcome, as critical, whereas the ACP guideline committee gave greater weight to quality-of-life issues (such as the burdens of monitoring and injections and the risk for hypoglycemia) in deciding to offer clinicians and patients a choice of several agents for second-line therapy,â€ť they wrote.
â€śThe ACP acknowledged cost in its guidelines as well, but thought that in the United States â€” where pricing, access, and insurance coverage vary â€” cost might play a greater or lesser role relative to the risk for hypoglycemia for many patients,â€ť Humphrey and colleagues added, also noting that evidence is lacking to support targeting normal fasting blood glucose levels among persons with type 2 diabetes. â€“ by Janel Miller
Please see the studies for the authorsâ€™ relevant financial disclosures. Source: https://www.healio.com/family-medicine/diabetes/news/online/%7Ba1143741-6eec-4f54-a0e6-51df1937e42d%7D/who-releases-recommendations-for-treating-adults-with-diabetes