Strong recommendation given for addition of SGLT-2 or GLP-1 agonist to metformin and lifestyle modifications
MONDAY, April 22, 2024 (HealthDay News) — In a clinical guideline issued by the American College of Physicians (ACP) and published online April 19 in the Annals of Internal Medicine, recommendations are presented regarding newer pharmacologic treatments for adults with type 2 diabetes. Details of the guideline were also presented at the Internal Medicine Meeting, the annual meeting of ACP, held from April 18 to 20 in Boston.
Amir Qaseem, M.D., Ph.D., from ACP in Philadelphia, and colleagues developed clinical guidelines based on the best available evidence for effectiveness, comparative benefits and harms, consideration of patients” values and preferences, and costs for type 2 diabetes treatments. The effectiveness and harms of newer pharmacologic treatments, including glucagon-like peptide-1 (GLP-1) agonists, a GLP-1 agonist and glucose-dependent insulinotropic polypeptide agonist, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and long-acting insulins were reviewed.
For adults with type 2 diabetes and inadequate glycemic control, the authors recommend the addition of an SGLT-2 inhibitor or GLP-1 agonist to metformin and lifestyle modifications (strong recommendation). An SGLT-2 inhibitor can reduce the risk for all-cause mortality, major adverse cardiovascular events, chronic kidney disease progression, and hospitalization due to congestive heart failure. Use of a GLP-1 agonist can reduce the risk for all-cause mortality, major adverse cardiovascular events, and stroke. To reduce morbidity and all-cause mortality, the addition of a DPP-4 inhibitor to metformin and lifestyle modification is not recommended for adults with type 2 diabetes and inadequate glycemic control (strong recommendation).
“ACP continues to recommend starting treatment with metformin and adding other agents only when glycemic goals are not met or comorbid conditions warrant their use,” Fatima Z. Syed, M.D., from Duke University in Durham, North Carolina, writes in an accompanying editorial.
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