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Treating Type 2 Diabetes: Looking Ahead - Episode 6

Revised ADA Guideline Recommendations for the Treatment of T2DM

Takeaways of the most recent ADA guidelines in terms of treating patients with diabetes with metformin, SGLT2 inhibitors, and GLP-1 receptor agonists.

Davida Kruger, NP: Let’s discuss some of the new American Diabetes Association guidelines. In 2021 they were updated, and what happened, which is phenomenal history, is back in 2008, there was a problem with some of our medications, the TZDs [thiazolidinediones] and whether they caused an increased risk of cardiovascular disease. At the end of the day, they probably did not. But the FDA said if you’re going to bring a new medication to the market, you could only do it if you did some cardiovascular studies. The medications, which were mostly SGLT2 inhibitors and GLP-1 receptor agonists, had to prove that they did not cause any more cardiovascular issues than a placebo did. I was an investigator for a number of these studies because they were long-term studies. At the end of the day, we made history. In the GLP-1 arena, they were decreasing the risk of MACE [major adverse cardiac event], 3-point MACE: decreasing stroke, heart attacks, and all-around death. And the SGLT2 inhibitors, aside from what they did for the kidneys, decreased risk of heart failure. Now we’re saying, after metformin, way before insulin…your first injectable would be the GLP-1s. For renal and cardiovascular [conditions], we now have 2 medications that help. As the benefit was shown in the research, it was more impressive than some of the first statins that came to market. How are you using these medications? I know that your focus is cardiovascular, but you’re seeing so many patients with diabetes. What would you do in your practice?

Margo B. Minissian, PhD, ACNP: Thank you so much for this. We were excited in cardiology to have these drugs available to us. It’s profound when you can create such a staple for both cardiovascular science, as well as endocrinology. These medications are vital for many of our patients. Typically, when I see a patient who has type 2 diabetes and is not on treatment, and unfortunately, I see a lot of women who fall into this group. What I do is I prescribe them metformin right out of the gate if they have not tried it yet. Then I refer them to our diabetes outpatient center, which is a comprehensive group of endocrinologists, it has a dietician, it has masters-prepared nurses who are all experts in teaching everything from nutrition to medication compliance. They’re good about getting the medications approved too, which is the other piece to it, just like how I’m very good at getting these other nonstatin cholesterol-lowering drugs into the hands of patients. It’s important that we refer. Get them on something and then get them referred. If you don’t have that luxury, then we have the autonomy to get them started. You are absolutely following national guidelines to do so if they’re not meeting their target hemoglobin A1C [glycated hemoglobin]. We’re very fortunate, we’re in an inner-city area, we have a lot of resources. In this instance, I’m always referring and reminding of the dual benefit. And I will elaborate on their cardiovascular risks so that they can utilize those providers who are on the endocrine team for getting these medications preapproved.

Davida Kruger, NP: I want to thank our audience for watching HCPLive® Peers & Perspectives. If you enjoyed the content, please subscribe to our e-newsletter to receive upcoming Peers & Perspectives and other great content right in your inbox. I receive it, and I love it when I see it in there. Take some time to enjoy it. Thank you again for joining us.

Transcript edited for clarity.