AACE/ACE Updates Algorithm for Type 2 Diabetes Management

“It’s easier to manage patients with diabetes as new therapies proliferate. Despite the initial challenge posed by these new medications, their multiplicity provides the potential for better matching of patient characteristics to medication profiles. Thus, better outcomes in the near term are expected,” said Dr Garber, who is also a professor in the departments of medicine and molecular and cellular biology at Baylor College of Medicine in Houston. 

In terms of medical treatment options for type 2 diabetes, the task force prioritizes minimizing the risks for hypoglycemia and weight gain. Therapy choices in the algorithm are then further stratified based on the patient’s initial HbA1c level. Guidance is offered on which therapies to initiate and which therapies should be added to a patient’s treatment regimen if glycemic targets are not achieved.

However, the task force emphasizes that individual circumstances dictate specific treatment regimens and that clinicians should consider a patient’s therapeutic goals, age, and other factors that may limit treatment.

Combination therapy is often required and should involve agents with complementary mechanisms of action, according to the algorithm.

“HbA1c goals have not changed. We still use personalized goals. Hypoglycemia may be less of a problem, as there are more medications which avoid that serious adverse outcome in their product profile,” said Dr Garber.

The algorithm also addressed insulin therapy, with Dr Grunberger noting that the insulin section expands the practical guidance for dose titration.

Simplifying Care

The algorithm is comprehensive in nature, said Dr Garber, but it is presented as an illustrated, action-driven treatment pathway. He noted that this approach can assist decision-making for physicians who are regularly challenged with managing the many facets of type 2 diabetes in the most effective and safe manner.

Furthermore, many new diabetes medications have been added to the armamentarium, Dr Grunberger explained, and it has been difficult for endocrinologists to keep up and use them appropriately.

“The AACE algorithm is the only one which provides [clinicians] with simple-to-follow practical directions based on available evidence, and in some cases, expert opinion where no evidence yet exists,” he told Endocrinology Advisor.

“Rather than the usual encyclopedic enumeration of all the medications on the market, the algorithm provides endocrinologists with a valued tool when they are teaching primary care and non-endocrinology colleagues about the current therapeutic choices,” Dr Grunberger said.

References

1. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2016 Executive Summary. Endocr Pract. 2016;22(1):84-113.
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4. Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm 2016. American Association of Clinical Endocrinologists website. https://www.aace.com/publications/algorithm. Published January 5, 2016. Accessed January 19, 2016.