ACP Updates Clinical Guidelines for Type 2 Diabetes Treatment

According to new clinical guidelines released this week by the American College of Physicians (ACP), doctors should prescribe metformin as a first-line therapy for patients with type 2 diabetes in cases where medication is necessary to lower high blood sugar levels.

The updated guidelines, which were published Jan. 3 in the Annals of Internal Medicine, have been endorsed by the American Academy of Family Physicians.

"Metformin, unless contraindicated, is an effective treatment strategy because it has better effectiveness, is associated with fewer adverse effects, and is cheaper than most other oral medications," said Nitin S. Damle, MD, MS, MACP, president. ACP. "The escalating rates of obesity in the U.S. are increasing the incidence and prevalence of diabetes substantially. Metformin has the added benefit of being associated with weight loss.

In cases where metformin is not enough to reduce high blood sugar levels, the new guidelines suggest four class options of add-on medications: sulfonylurea, thiazolidinedione, SGLT-2 inhibitor, or DPP-4 inhibitor.

"Adding a second medication to metformin may provide additional benefits," Dr. Damle said. "However, the increased cost may not always support the added benefit, particularly for the more expensive, newer medications. ACP recommends that clinicians and patients discuss the benefits, adverse effects, and costs of additional medications."

Although the updated guidelines do not include injectables like insulin or GLP-1RAs, Dr. Damle says the next update may include them and recommends that patients be offered the full range of available treatment options when necessary.

"We want to use as many oral agents as possible to maximize efficacy before going to injectable form."

ACP follows a rigorous process for developing clinical practice guidelines, which includes a thorough review of evidence taken from randomized control trials and data from observational studies. The guidelines also identify gaps in clinical evidence and help set the direction for future research.

To learn more about the updated guidelines, read the full text.