A new position paper from leading diabetes societies calls for add-on therapy within 3 months if patients do not reach glycaemic goals, and represents a significant shift away from current NICE guidelines.
The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) joint position statement calls for a more patient-centred approach which allows medication choice to be more open than currently recommended by NICE. The new approach encourages use of a range of diabetes therapies that are currently used third of fourth line, such as exenatide, gliptins and basal insulin.
The statement highlights the need to allow for individual patient's needs, preferences and tolerances, and to take into account that type 2 diabetes patients differ substantially in terms of age, disease progression and co-morbidities. At the same time it aims to be less prescriptive as there is little evidence to distinguish the effectiveness of therapy options following metformin.
The significant cost implications of such an approach will be reviewed in future NICE guidelines on the management of type 2 diabetes. Current NICE 2009 guidelines for diabetes recommend sulphonylureas are used second line, with new oral therapies reserved for when there is a particular risk of hypoglycaemia or the patient does not tolerate, or has a contraindication to, sulphonylureas. Use of insulin is recommended only if HbA1c levels remain high after using other treatments.
The study can be viewed on the EASD website from the link below.
European Association for the Study of Diabetes (EASD) - http://188.8.131.52/easd_intranet/easdwebfiles/statements/type2guidelines/type2guidelines.html