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.
In the updated clinical guideline, ACP recommends 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 peptidase-4
(DPP-4) inhibitor to metformin and lifestyle modifications in
adults with Type 2 diabetes and inadequate glycemic control because
high-certainty evidence showed that adding a DPP-4 inhibitor does
not reduce morbidity or all-cause mortality.
"As additional pharmacological treatments become available for
the treatment of Type 2 diabetes, it's critical for us to examine
their effectiveness, the harms and benefits as well as costs in
order to provide the best treatment for our patients," 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 and harms of newer 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 events, myocardial
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
goal. It is known that 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.
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, and personal preferences
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.
About the American College of Physicians
The American College of Physicians is
the 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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SOURCE American College of Physicians