ADA-EASD-guideline on management of Type 2 Diabetes

A consensus report by the American Diabetes Association (ADA) and the European. Association for the Study of Diabetes (EASD).

GLUCOSE - LOWERING MEDICATION IN TYPE 2 DIABETES : OVERALL APPROACH ESTABLISHED ASCVD OR CKD ASCVD PREDOMINATES EITHER / OR GLP-1 RA with proven CVD benefit (1) SGLT2i with proven CVD benefit (1) if eGFR adequate (2) If HbA1c above target If further intensification is required or patient is now unable to tolerate GLP-1 RA and / or SGLT2i choose agents demonstrating CV safety Consider adding the other class( GLP-1 RA or SGLT2i ) with proven CV benefit DPP-4i if not on GLP-1 RA Basal insulin (4) TZD (5) SU (6)

HF OR CKD PREDOMINATES-PREFERABLY SGLT2i with evidence of reducing HF and / or CKD progression in CVDTs if eGFR adequate If SGLTi not tolerated or contraindicated or if eGFR less than adequate (2) add GLP-1 RA with proven CVD benefit (1) If HbA1c above target Avoid TZD in setting of HFConsider agents demonstrating CV safety Consider adding the other class with proven CVD benefit (1) DPP-4i ( not saxagliptin ) in the setting of HF ( if not on GLP-1 RA ) Basal insulin (4) SU(6)

Proven CVD benefit means...