9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2023

Abstract

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

GLP-1R Signaling and Functional Molecules in Incretin Therapy

“…With the progression of the disease, metformin alone cannot maintain blood glucose at the desired level, and combination therapies become necessary. The selection of combined medication, including sulfonylureas, alpha-glucosidase inhibitors, thiazolidinediones, dipeptidyl peptidase 4 inhibitors (DPP4i), GLP-1 agonists, and sodium-dependent glucose transporters 2 inhibitors (SGLT2i) [ 2 , 119 ], is based on clinical characteristics and patients’ preferences.…”

“…In summary, the importance of incretin in blood glucose modulation has been fully recognized [ 119 ]. Incretin therapy is the focus of significant drug development and has become one of the most promising therapies for T2DM.…”

Elderly Female of Type 2 Diabetes (T2D) and Dementia with Clinical Improvement by Imeglimin (Twymeeg)

“…Recent OHAs include sodium-glucose cotransporter 2 inhibitor (SGLT2i) and oral administration of glucagon-like-peptide 1 receptor agonist (GLP1-RA) [4]. Furthermore, the latest novel OHA is imeglimin (Twemeeg) that shows dual efficacy of increasing insulin secretion and decreasing insulin resistance [5,6]. The characteristic point of imeglimin includes the similarity of molecules with metformin [7].…”

Optimal Low-Density Lipoprotein Cholesterol Level for Primary Prevention in Koreans with Type 2 Diabetes Mellitus

“…A linear relationship between low-density lipoprotein cholesterol (LDL-C) level and incident CVD has been observed in patients with DM, as well as in individuals without DM [2,3]. Lowering LDL-C levels with statin therapy is currently a mainstay of dyslipidemia management in people with DM [4][5][6][7][8]. Previous randomized controlled trials of statins such as the Collaborative Atorvastatin Diabetes Study (CARDS) have shown that use of statins reduced the risk of adverse cardiovascular events in patients with type 2 diabetes mellitus (T2DM) [9].…”

“…These trials demonstrated that an LDL-C level less than 70 mg/dL was achievable with intensive management, resulting in a lower incidence of adverse cardiovascular events than that with higher levels of LDL-C using low-to moderate-intensity statins. Accordingly, the 2023 American Diabetes Association guideline recommends using high-intensity statins to reduce LDL-C levels by ≥50% of the baseline and to <70 mg/dL in patients with DM aged 40 to 75 years at high cardiovascular risk [4]. Similarly, the 2021 European Society of Cardiology recommends LDL-C level less than 70 mg/dL for patients with T2DM [5].…”