Therapy of Type 2 Diabetes

Abstract

Influenceable▪ Visceral obesity ▪ Fatty liver ▪ Depression ▪ Obstructive sleep apnoea (OSA) ▪ Physical inactivity ▪ High-energy, low-fibre food ▪ High sugar consumption (soft drinks etc.) ▪ Excessive alcohol consumption (fatty liver) ▪ Smoking ▪ Diabetogenic drugs ▪ Diabetogenic environment (e. g., deprivation) = disadvantage due to lack of resources, exposure to excessive chronic noise and air pollution) Metabolic syndrome [2] At least 3 out of 5 criteria must be fulfilled: ▪ Abdominal obesity (waist circumference): male *> 94 cm; female ** > 80 cm ▪ Triglycerides *** : ≥ 150 mg/dl or ≥ 1.7 mmol/l ▪ HDL cholesterol *** : male < 40 mg/dl or < 1.03 mmol/l; female: < 50 mg/dl or < 1.29 mmol/l ▪ Elevated blood pressure *** : ≥ 130/ ≥ 85 mmHg ▪ Fasting plasma glucose *** : ≥ 100 mg/dl or ≥ 5 mmol/l or pre-existing diabetes * / ** People from: Southeast Asia or China: 90/80 cm; Japan: 90/85 cm *** Pharmacological intervention is an alternative criterion This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Clinical characteristics, treatment patterns, and persistence in individuals with type 2 diabetes initiating a glucagon‐like peptide‐1 receptor agonist: A retrospective analysis of the Diabetes Prospective Follow‐Up Registry

“…These recommendations are based on findings from large‐scale cardiovascular outcome studies 22‐25 . In addition, for patients without an increased risk of atherosclerotic cardiovascular disease, add‐on therapy to metformin is recommended with a GLP‐1 RA to minimize hypoglycaemia risk and weight gain or to promote weight loss 3,4,6,21 in an individualized treatment approach. The more recent recommendations to introduce GLP‐1 RA therapy earlier in the treatment paradigm may not be reflected in the overall population of individuals with T2D from the DPV Registry as this analysis spans the entire time period from the introduction of the first GLP‐1 RA up to 2020.…”

“…3,4 This guidance was further endorsed in a review of guideline recommendations that examined the positioning of newer antidiabetic medications 5 and by national guidelines issued in Germany. 6 Persistence and adherence to therapy are key factors to ensure the benefits of therapy, including optimal glycaemic control and reductions in cardiovascular outcomes in individuals with T2D. 7 Retrospective database analyses have examined treatment prescriptions in individuals with T2D initiating GLP-1 RAs in European countries, including Germany.…”

Glycaemia in low-premixed insulin analogue type 2 diabetes patients in a real-world setting: are the CGM targets met?

“…The standard glycemic parameters (measured HbA1c, preprandial and postprandial glucose) were all slightly above the recommended targets for the general type 2 diabetes population but satisfactory for older adults [3,5,13]. The patients received standard guideline-informed concomitant antihyperglycaemic therapy that was not expected to cause or contribute to hypoglycemia [2,3,5].…”

“…The currently recommended way of starting insulin therapy in people with T2D is the addition of basal insulin to the prior pharmacological treatment in conjunction with revisiting health behaviour and diabetes self-management education and support. Only when combination therapies with basal insulin are no longer sufficient, the next step is to further intensify therapy with prandial insulin [2,3,5].…”

Aktualisierte S2k-Leitlinie nicht-alkoholische Fettlebererkrankung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – April 2022 – AWMF-Registernummer: 021–025

“…Diese Zielgruppe ist dadurch gekennzeichnet, dass in der Regel eine fortgeschrittene, dekompensierte Leberzirrhose oder ein HCC vorliegt. Leider enthalten aktuelle diabetologische Konsensuspapiere und Leitlinien keine spezifischen Empfehlungen für antidiabetische Therapien bei Patienten mit terminaler Lebererkrankung 530 531 532 , da Patienten mit fortgeschrittener Lebererkrankung oft von Therapiestudien ausgeschlossen sind 533 . Vor diesem Hintergrund liegt keine klare Evidenz bezüglich der optimalen antidiabetischen Pharmakotherapie bei Patienten mit fortgeschrittener Leberzirrhose vor.…”