DDG Congress presented new diabetes guidelines

Professional societies present a new guideline

05/16/2012

At the beginning of this year's annual meeting of the German Diabetes Association (DDG) a new guideline for diabetes type II patients of the European and American Society for Brisance was published. For example, no general stringent blood glucose goals are more recommended.

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have published a new common guideline as a draft. Accordingly, the blood sugar level should always be determined individually on the characteristics of the diabetic (type 2). Fundamental to the treatment but remain continuous movement, lifestyle changes and diabetes education of those affected. Furthermore, according to the guideline, the drug metformin should remain the drug of first choice, if there are no medical reasons against it. Alternative medicines, however, are only available to a limited extent, as most of them have "limited evidence". However, the guidelines state that communication tools can be used.

Co-decision of the patient important
If physicians choose a drug therapy, advantages and disadvantages in terms of adverse effects should be weighed up. In controlling the metabolism, sufferers will continue to require insulin in monotherapy or combination therapies. The co-decision of the patient is of great importance to ensure adherence. Therefore, diabetics should be able to decide for the therapies. Clear main goal remains the reduction of weight as well as the lowering of cardiovascular risk (cardiovascular diseases such as heart attack). What is new now is that the professional societies no longer give concrete specifications with strict targets for the cessation of blood sugar.

A positive assessment Michael Albrecht Nauck from the Diabetes Center Bad Lauterberg the innovations. Thus the physician told the "Ärztezeitung": "There is no single medicine approved which tastes neither the prescribing doctor nor the patient". The diabetes expert had himself worked on the new guidelines. Rather, the therapy can now be geared to the findings and the needs of the patient. "The fact that HbA1c has no more numbers is not important," said Nauck. Basically, a norm is always sought close to a setting, "if the patient has a long life expectancy, and if the setting with proven drugs and reasonable effort succeeds." Then, for example, a glycohaemoglobin value of 6.5 percent is justifiable. The general therapeutic goal generally states that the value should be kept below 7 to 8 percent in order to delay or avoid secondary diseases.

Not too big therapy goals in older patient groups
The diabetologist warned the newspaper against excessive therapy goals in elderly patients with cardiovascular diseases. The recent study "ACCORD" has shown that therapists should not try to "give one drug after another and increase the dose to infinity." In subjects who were heavily drugged and reached a value below six percent, it turned out Compared to other study participants a higher mortality rate of 22 percent. Thus, high doses in the elderly may be contraindicated in life expectancy.

Nauck shows an example to the Ärzte Zeitung: If, in the case of a 90-year-old patient, the value of metformin therapy was 8 percent, physicians should in his opinion avoid "administering" insulin because hypoglycemia poses a much greater risk than the elevated blood sugar level. Especially cardiac arrhythmias or falls caused by hypoglycemia are particularly dangerous for the patient. In addition, older people with Type II diabetes are taking multiple medicines at the same time, which can lead to dangerous interactions. In addition, elderly sufferers usually suffer from impaired kidney function. Many older people are also often overburdened with intensified insulin therapy.

Even with athletes who dive or mountaineering, it is important to "avoid hypoglycemia, because they can easily become life-threatening in certain situations," said Nauck. The choice of remedies must be made in consultation with the patient and priorities set.

Medicines that lead to obesity
This approach should also apply to remedies that produce weight gains. Patients often wish to lose their excess weight. Nauck emphasizes that if patients want to get rid of their superfluous finds, move more and pay attention to a healthy diet, "then one should not counteract this with medications that do the opposite."

The expert critically examines the recommendations made to date for some medicines in the antidiabetics class. The ADA and the EASD had "very much leaned out of the window" on some points. For example, the active substance sulfonylurea was recommended as a second-line metformin. However, the data published so far would not confirm such a preferred recommendation. Therefore, in the new guidelines, glitazones, DPP-4 inhibitors, GLP-1 agonists and insulin are also indicated as secondary agents.

Changing the lifestyle of great importance
Following a diagnosis of diabetes, the implementation of lifestyle change should continue to be a high priority. Patients should be motivated to support the measures to change their lives and be encouraged to participate from the beginning. If the blood sugar level can be almost reached to the individual target value, a period of three to six months should be set for this patient group before the doctor advises to adjust the medication. However, if it is already clear after the diagnosis that the patient does not see any possibilities to change his previous life, it may make sense to start with the metformin therapy right from the beginning, as the new guidelines state.

According to the expert, there are already suggestions from colleagues to revise the guidelines again. Nauck could imagine, however, that "essential elements of this patient-centered approach to be adopted". The annual convention of the German Diabetes Society started today in Stuttgart and ends on Saturday. (Sb)

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