- By Deb Balzer
Mayo Clinic expert responds to new Type 2 diabetes guidelines
The American College of Physicians has come out with new guidelines for treating Type 2 diabetes. The group advises clinicians to prescribe metformin to patients with Type 2 diabetes as first-line therapy. Then adding to the metformin — a sulfonylurea, a thiazolidinedione, an SGLT-2 inhibitor, or a DPP-4 inhibitor, when a second oral therapy is considered. Mayo Clinic endocrinologist Dr. Adrian Vella says the guidelines "break no new ground in terms of therapeutic hierarchy and are confined to oral pharmacotherapy. While an excellent compilation of available safety and efficacy data, there is little novelty in treatment recommendations."
Dr. Vella says, "The review is not necessarily comprehensive, as three oral drug classes are omitted, although there is not much data to support their use as primary therapy (i.e., dopamine agonists, bile-acid binding resins and acarbose). Furthermore, by confining the recommendations to oral medications, another class of injectable medication – glucagon-like peptide-1 receptor agonists - is omitted completely. These medications are associated with some weight loss and recently (like SGLT-2 inhibitors) have been associated with cardiovascular benefit. Lifestyle modification up front is not emphasized. And I think the guideline might overplay the potential benefits of metformin as a first-line drug, which may not be ideal for all patients."
He adds, "The role of dietary modification and exercise, especially early in the disease, should not be overlooked."
- Mayo Clinic Minute: Type 2 diabetes – What you need to know (Nov. 14, 2016)