WHO Issues Recommendations for Tx Intensification in T2DM
HealthDay News — Recommendations have been developed by the World Health Organization for treatment intensification in type 2 diabetes. The recommendations were published online September 4 in the Annals of Internal Medicine.
Gojka Roglic, MD, and Susan L. Norris, MD, MPH, from the World Health Organization in Switzerland, developed recommendations to provide guidance on medicine selection for treatment intensification in type 2 diabetes, and use of insulin in type 1 and 2 diabetes.
The researchers developed 5 recommendations. One, a sulfonylurea should be given to patients with type 2 diabetes who do not achieve glycemic control with metformin alone or who have contraindications to metformin. Two, human insulin treatment should be introduced to patients with type 2 diabetes who do not achieve glycemic control with metformin and/or a sulfonylurea. Three, a dipeptidyl peptidase-4 inhibitor, a sodium-glucose contransporter-2 inhibitor, or a thiazolidinedione may be added if insulin is unsuitable. Four, in adults with type 1 diabetes, and in adults with type 2 diabetes for whom insulin is indicated, human insulin should be used to manage blood glucose. Five, long-acting insulin analogues should be considered to manage blood glucose in adults with type 1 or type 2 diabetes who have frequent, severe hypoglycemia with human insulin.
"The decision to name sulfonylureas as the single best second-line agent largely reflects the prioritization of cost and the recognition that WHO guidelines must apply to low-resource settings," write the authors of an accompanying editorial.