- Design
- Consensus report based on systematic examination of evidence since 2022
- Population
- Non-pregnant adults with type 2 diabetes
- Primary outcome
- Updated management recommendations
- Effect
- Earlier SGLT2 inhibitor and/or GLP-1-based therapy, potentially from diagnosis; earlier combination in CVD, CKD and heart failure
The American Diabetes Association and the European Association for the Study of Diabetes have updated their joint consensus report on managing type 2 diabetes in non-pregnant adults, the first revision since 2022, based on a systematic review of evidence published since then.
The framing moves from treating hyperglycaemia to managing type 2 diabetes as a condition with many linked long-term complications. The report advocates earlier use of SGLT2 inhibitors and GLP-1-based therapies, potentially from diagnosis, for organ protection, and says combined use of the two should be considered earlier in people with established cardiovascular disease, chronic kidney disease or heart failure. Lifestyle, including sleep and 24-hour physical behaviour, avoidance of tobacco and other substances, psychological support and weight management sit alongside the drugs as fundamentals.
The report closes on implementation: the gains it describes come from consistent use of drugs and strategies already available. In Indian practice, generic SGLT2 inhibitors are now inexpensive, while GLP-1-based therapies remain costlier, so the combination recommendation will meet access limits that the report's US and European audience does not face. Indian guidance from RSSDI is separate and has not been updated by this report.
- Consider an SGLT2 inhibitor or a GLP-1-based therapy at diagnosis for organ protection, not only after metformin fails.
- Consider combining the two classes in people with cardiovascular disease, chronic kidney disease or heart failure.
- Screen for kidney disease, heart failure and cardiovascular disease at diagnosis, since they drive drug choice.
- Ask about sleep, tobacco and mental health as part of the diabetes review, as the report treats these as fundamentals.
Why it matters
Choosing the first drug becomes a question of which organs to protect, not how far to lower HbA1c.
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