Q&A: Paradigm Shifts in Type 2 Diabetes Management

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Statistics indicate that type 2 diabetes (T2D) affects approximately 14% of the global population. This is significant because T2D is linked to various complications, including vision loss, kidney failure, cardiovascular disease, and a higher mortality rate. Current guidelines encourage early intervention with newer treatment options, including sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonist (GLP-1RA) medications. Given the shifting approaches to T2D management, Deborah J. Wexler, MD, MSc, and colleagues developed a literature review addressing this topic.

Initially, the team identified 2,016 articles for examination, and after applying the exclusion criteria, the review included 126 articles. Of these articles, 47 were randomized clinical trials, 22 were observational studies, 21 were categorized as systematic reviews and/or meta-analyses, 21 were guidelines developed, and 12 were narrative reviews. Additionally, three pharmaceutical or device reference guides were included. The authors published the results of this review in JAMA. Dr. Wexler spoke with Physician’s Weekly about the findings of this examination and their applicability to practice.

Physician’s Weekly: Why did you feel this topic needed an in-depth review?

Dr. Wexler: Since the last JAMA review on this topic, a paradigm shift has occurred in diabetes management. Two new classes of diabetes medications, SGLT2 inhibitors and GLP-1 receptor agonists, have demonstrated benefits in improving the management of hyperglycemia and weight, while also reducing the risk of heart and kidney disease. The new review summarizes these updates and provides guidance on the new approach to treatment management.

What are some of the long-term complications that healthcare providers need to address while treating patients with T2D? 

Diabetes causes acute complications when blood sugar levels are high, and chronic complications such as heart, kidney, eye, and nerve damage over time. Good management of diabetes and its associated conditions can prevent or delay complications.

How can practitioners address lifestyle changes?

Lifestyle change is the foundation of diabetes management. Practitioners should meet people where they are, aiming to agree on achievable goals for lifestyle change, building on prior successes to yield sustained healthy habits. An initial goal may be as simple as eliminating sugar-sweetened beverages such as juice or soda or increasing walking over the course of the day. Referrals to dietitians or diabetes self-management programs are both evidence-based approaches that improve diabetes management and [a] healthy lifestyle. 

As concluded by the researchers of the review, “T2D affects up to 14% of the global population and is associated with preventable long-term complications such as cardiovascular disease, kidney failure, vision loss, and increased mortality. In addition to lifestyle modifications, including diet, exercise, and weight management, metformin is generally first-line therapy for attainment of HbA1C targets. For individuals with T2D and cardiovascular or kidney disease or at high cardiovascular risk, guidelines recommend early treatment with SGLT2i and/or GLP-1RA medications.”

Disclosure(s): Dr. Wexler has indicated to Physician’s Weekly that she served on data monitoring committees for Novo Nordisk for trials concluding in 2024 outside the submitted work.