Clinical guidelines on the treatment of type 2 diabetes mellitus were published in March 2022 by the Società Italiana di Diabetologia (SID) and the Associazione Medici Diabetologi (AMD), in Acta Diabetologica.
In patients with type 2 diabetes who are undergoing treatment with drugs that can induce hypoglycemia, it is recommended that the target hemoglobin A1c (HbA1c) level be between 49 mmol/mol (6.6%) and 58 mmol/mol (7.5%).
In patients with type 2 diabetes who are undergoing treatment with drugs that cannot induce hypoglycemia, it is recommended that the target HbA1c level be below 53 mmol/mol (7%).
It is suggested that structured medical nutrition therapy (made up of nutritional assessment, diagnosis, intervention, and monitoring) be employed in type 2 diabetes treatment.
Regular physical exercise is suggested for type 2 diabetes treatment.
Combined (aerobic and resistance) training, rather than aerobic training alone, is suggested for type 2 diabetes treatment.
In patients with type 2 diabetes who have not had previous cardiovascular events, metformin is recommended as a first-line, long-term treatment. As second-line agents, sodium-glucose cotransporter-2 (SGLT-2) inhibitors or glucagon-like peptide-1 (GLP-1) receptor agonists are recommended, while as third-line treatments, consideration should be given to pioglitazone, dipeptidyl peptidase 4 (DPP-4) inhibitors, acarbose, and insulin.
In patients with type 2 diabetes with previous cardiovascular events but without heart failure, the use of metformin, SGLT-2 inhibitors, or GLP-1 receptor agonists is recommended as first-line, long-term treatment. As second-line treatments, consideration should be given to DPP-4 inhibitors, pioglitazone, acarbose, and insulin.
In patients with type 2 diabetes who have suffered previous heart failure, SGLT-2 inhibitors are recommended for first-line, long-term treatment. Consideration should be given to GLP-1 receptor agonists and metformin as second-line treatments, and to DPP-4 inhibitors, acarbose, and insulin as third-line treatments.
It is recommended that all patients with type 2 diabetes who require treatment with basal insulin receive basal insulin analogues rather than neutral protamine Hagedorn (NPH) insulin.
It is not suggested that in patients with type 2 diabetes who are on basal-bolus insulin therapy, continuous glucose monitoring (continuous or on demand) instead of self-monitoring of blood glucose be practiced.
For more information, please go to Type 2 Diabetes Mellitus.
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Cite this: Type 2 Diabetes Mellitus Clinical Practice Guidelines (SID/AMD, 2022) - Medscape - Mar 31, 2022.