Approaches to Glycemic Treatment
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new class of diabetes medications and have been added to the recommendations for treatment. Examples of SGLT2 inhibitors include Invokana, Farxiga, and Jardiance. Characteristics of SGLT2 inhibitors include:
Combination injectable therapy is recommended for people who cannot achieve their A1C target after 3 months of triple therapy. Patients should receive metformin + basal insulin + mealtime insulin or GLP-1-receptor agonist.
Cardiovascular Disease and Risk Management
The diastolic blood pressure goal was changed from 80 mmHg to 90 mmHg because recent meta-analysis comparing intensive blood pressure target (130/80mmHg) to standard targets (140-160/85-100 mmHg) did not show any significant reduction in mortality or heart attacks. However, some patients may still benefit from the lower diastolic goal of 80mmHg.
Statin treatment and lipid monitoring have changed from LDL level-driven to risk status-driven to better reflect the changes in the 2013 American College of Cardiology/American Heart Association guideline. Lipid profile screening should occur when diabetes is diagnosed, at initial medical evaluation and/or at age 40, and periodically thereafter.