Antihyperglycemic Agent Therapy for Adult Patients with Type 2 Diabetes Mellitus 2017: A Position Statement of the Korean Diabetes Association

Abstract

In 2017, the Korean Diabetes Association (KDA) published a position statement on the use of antihyperglycemic agents for patients with type 2 diabetes mellitus (T2DM). The KDA regularly updates its Clinical Practice Guidelines, but since the last update in 2015, many results from clinical trials have been introduced, and domestic data from studies performed in Korean patients with T2DM have been published. Recently, evidence from large clinical studies assessing cardiovascular outcomes following the use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with T2DM were incorporated into the recommendations. Additionally, new data from clinical trials using dipeptidyl peptidase 4 inhibitors and thiazolidinediones in Korean patients with T2DM were added. Following a systematic review and assessment of recent evidence, the KDA updated and modified its clinical practice recommendations regarding the use of antihyperglycemic agents and revised the treatment algorithm for Korean adult patients with T2DM.

Insulin therapy for adult patients with type 2 diabetes mellitus: a position statement of the Korean Diabetes Association, 2017

“…In patients above the HbA1c target on basal insulin or premixed insulin once or twice daily, recommendations for further intensification, if needed, are outlined in Fig. 1 [ 31 ]. When physicians intensify an insulin regimen, they should consider the advantages and disadvantages such as flexibility, complexity, and frequency of hypoglycemia.…”

“…The width of each black line reflects the strength of the expert consensus recommendations. Adapted from Ko et al [ 31 ].…”

Efficacy and safety of ipragliflozin as an add‐on therapy to sitagliptin and metformin in Korean patients with inadequately controlled type 2 diabetes mellitus: A randomized controlled trial

“…In line with the IDF guidelines, the Korean Diabetes Association guidelines recommend managing T2DM with an initial therapy of metformin, in conjunction with lifestyle modification 4, 5. Dual therapy may be considered if patients' initial glycated haemoglobin (HbA1c) level is ≥7.5% or if the HbA1c target is not achieved within 3 months of initiating metformin monotherapy 4, 5.…”

“…Dual therapy may be considered if patients' initial glycated haemoglobin (HbA1c) level is ≥7.5% or if the HbA1c target is not achieved within 3 months of initiating metformin monotherapy 4, 5. If inadequate glycaemic control persists with dual therapy, a third agent with a complementary action may be added 5.…”

“…Dual therapy may be considered if patients' initial glycated haemoglobin (HbA1c) level is ≥7.5% or if the HbA1c target is not achieved within 3 months of initiating metformin monotherapy 4, 5. If inadequate glycaemic control persists with dual therapy, a third agent with a complementary action may be added 5. Because increased insulin resistance and diminishing β‐cell function tend to occur with T2DM progression, antidiabetic agents that target components of the glucose metabolism pathway may become less effective over time 6.…”