Embracing change in the new era of type 2 diabetes care
As one of the most common diseases in the United States, diabetes impacts more than 37 million Americans with 90-95% having type 2 diabetes.1 Type 2 diabetes symptoms can develop slowly over time, and may lead to serious complications including cardiovascular disease, retinopathy, nephropathy, and neuropathy.2 However, it is possible to manage the disease, and clinicians like yourself can play an important role in helping people living with type 2 diabetes achieve their health goals.
We know it is challenging for many people living with type 2 diabetes to manage the disease. In fact, a recent cross-sectional analysis of the U.S.-based National Health and Nutrition Examination Survey (NHANES) data found that the U.S. is trending in the wrong direction. After more than a decade of progress in the early 2000s, glycemic and blood-pressure control have declined in the adult population.3 This is particularly concerning given, today, more than ever before, the efficacy of new therapies, evidence-based treatment guidance for earlier and tighter management of both blood glucose and excess weight, and what patients are looking for in terms of their disease management line up well.
We are in a new era of care – or at least we should be.
Consistency Across Medical Capability, Guidelines and Patient Aspirations
After decades of science, research, and advancement, we have reached a time in type 2 diabetes care where medical capabilities align with what professional organizations and patients have been demanding — treatments that help control their A1C and reduce excess weight.
On the medical capability front, we have seen new, more innovative treatment options become available for patients over the last few years. These new treatments, including incretin-based therapies, are demonstrating efficacy in improving both A1C and body weight to greater extents than previously seen, while also potentially addressing other underlying issues patients may have. And many companies have even more treatments in the pipeline that offer various mechanisms of action and modes of administration, catering to an array of patient preferences.
From a science and guidelines perspective, there is also alignment. The science around type 2 diabetes care has demonstrated promise around early glucose control and weight management for the long-term health of patients.4,5 About 90% of people with type 2 diabetes also have obesity or overweight, demonstrating the importance of addressing excessive weight when treating these patients.6 And the American Diabetes Association (ADA) agrees. In its 2023 Standards of Care in Diabetes, ADA recommends early and consistent glucose and weight management since effective management of both can help reduce the risk of diabetes-related complications.7,8
And importantly, the innovation in treatment and care guidelines reflect what patients are looking for when it comes to managing their type 2 diabetes.9 When looking at treatment-related attributes that encouraged patients with type 2 diabetes to initiate and stay on their medications, treatment efficacy in managing A1C and losing weight, or at least not gaining weight, were the two most important factors.9 For likely the first time in type 2 diabetes care, patients can access treatments that match their wishes after decades of insulin and other treatments that resulted in weight gain instead of weight loss.
More Needs To be Done to Improve Type 2 Diabetes Care and Clinicians Play an Important Role
Unfortunately, despite the new era of care we are in, many people living with type 2 diabetes are not reaching care goals. In fact, it is estimated that only 45-60% of adults with type 2 diabetes have achieved the ADA-recommended A1C target of <7%.10,11
Clinicians may hesitate to incorporate new treatments into their practice for several reasons, including patient-related factors (education, engagement with treatment and therapy preferences), costs of the new medicine and reimbursement, among others.12
However, this new era of type 2 diabetes care only benefits patients if health systems and clinicians incorporate the latest research, care guidelines and medications where appropriate to help patients manage their type 2 diabetes. To start, clinicians can refer to the evidence-based treatment guidelines, tackle the issue of therapeutic inertia, and leverage patient desire for better glucose control and weight reduction through patient-centric care.
The ADA recommends that a person-centered approach be taken when choosing a treatment for people with diabetes, which may include the treatment of other risk factors to help improve patient outcomes across the board.13 Once those risk factors have been identified, clinicians and their patients can determine together which treatment options work best for them, while considering individual preferences.
Even though type 2 diabetes care has changed immensely over the years, and we’ve discovered new treatments that meet patient expectations, it will continue to evolve. Embracing this constant change and innovation will benefit patients and help them get back to the life they want to live with their disease more effectively managed.
1 Type 2 diabetes. Centers for Disease Control and Prevention. April 18, 2023. Accessed August 2023. https://www.cdc.gov/diabetes/basics/type2.html#:~:text=More%20than%2037%20million%20Americans,adults%20are%20also%20developing%20it.
2 Type 2 diabetes. Mayo Clinic. March 14, 2023. Accessed August 2023. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193.
3 Fang M, Wang D, Coresh J, Selvin E. Trends in diabetes treatment and control in U.S. adults, 1999–2018. June 10, 2021. Accessed August 2023. https://www.nejm.org/doi/full/10.1056/NEJMsa2032271.
4 Ko JH, Kim TN. Type 2 Diabetes Remission with Significant Weight Loss: Definition and Evidence-Based Interventions. J Obes Metab Syndr. 2022;31(2):123-133. doi:10.7570/jomes22001.
5 Laiteerapong N, Ham SA, Gao Y, et al. The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study). Diabetes Care. 2019;42(3):416-426. doi:10.2337/dc17-1144.
6 Type 2 diabetes and metabolic surgery: ASMBS. American Society for Metabolic and Bariatric Surgery. September 24, 2020. Accessed August 2023. https://asmbs.org/resources/type-2-diabetes-and-metabolic-surgery-fact-sheet.
7 ElSayed NA, Aleppo G, Aroda VR, et al. Glycemic Targets: Standards of Care in Diabetes—2023. American Diabetes Association. December 12, 2022. Accessed August 2023. https://diabetesjournals.org/care/article/46/Supplement_1/S97/148053/6-Glycemic-Targets-Standards-of-Care-in-Diabetes.
8 ElSayed NA, Aleppo G, Aroda VR, et al. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes—2023. American Diabetes Association. December 12, 2022. Accessed September 8, 2023. https://diabetesjournals.org/care/article/46/Supplement_1/S128/148043/8-Obesity-and-Weight-Management-for-the-Prevention.
9 Sims TJ, Boye KS, Robinson S, Kennedy-Martin T. Treatment-Related Attributes of Diabetes Therapies and How People with Type 2 Diabetes Report Their Impact on Indicators of Medication-Taking Behaviors. Patient Preference and Adherence. August 4, 2022. Accessed August 2023. https://www.dovepress.com/treatment-related-attributes-of-diabetes-therapies-and-how-people-with-peer-reviewed-fulltext-article-PPA.
10 Avramidis I, Apsemidou A, Lalia AZ, et al. Lessons From a Diabetes Clinic: Achieving Glycemic Goals and Clinical Use of Antidiabetic Agents in Patients With Type 2 Diabetes. Clin Diabetes. 2020;38(3):248-255. doi:10.2337/cd19-0090.
11 Avramidis I, Apsemidou A, Lalia AZ, et al. Lessons From a Diabetes Clinic: Achieving Glycemic Goals and Clinical Use of Antidiabetic Agents in Patients With Type 2 Diabetes . American Diabetes Association. July 1, 2020. Accessed August 2023. https://diabetesjournals.org/clinical/article/38/3/248/32205/Lessons-From-a-Diabetes-Clinic-Achieving-Glycemic.
12 Medlinskiene K, Tomlinson J, Marques I, Richardson S, Stirling K, Petty D. Barriers and facilitators to the uptake of new medicines into clinical practice: A systematic review - BMC health services research. BioMed Central. November 5, 2021. Accessed August 2023. https://doi.org/10.1186/s12913-021-07196-4.
13 ElSayed NA, Aleppo G, Aroda VR, et al. 4. Comprehensive Medical Evaluation and assessment of comorbidities: Standards of care in Diabetes-2023. American Diabetes Association. December 12, 2022. Accessed August 2023. https://diabetesjournals.org/care/article/46/Supplement_1/s49/148058/4-Comprehensive-Medical-Evaluation-and-Assessment.
