2020 ADA Guidelines Include SGLT2 Inhibitors, GLP-1 Receptor Agonists to Treat Comorbidities

In its annual revision of the Standards of Medical Care in Diabetes, the American Diabetes Association (ADA) outlined changes to its 2020 version of the guidelines.

Although there were many updates in various facets of diabetes care, one change stood out. New recommendations call for 2 drug classes to be used to treat patients with type 2 diabetes (T2D) and comorbidities: sodium glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. According to The Lancet, both treatments “showed a cardiovascular protection in dedicated outcome studies in patients with type 2 diabetes at high cardiovascular risk.”

In the section entitled Pharmacologic Approaches to Glycemic Treatment, authors state the inhibitors “should be considered for patients when atherosclerotic cardiovascular disease (ASCVD), heart failure, or chronic kidney disease predominates independent of [glycated hemoglobin] A1C.”

SGLT2 inhibitors induce a fasting state in patients, thus allowing for weight loss, a reduction in fatty liver disease, and a decreased risk for cardiovascular disease. In addition, this drug class does not raise insulin levels because the inhibitors cause glucose to be expelled through the urine.

This inclusion is a welcome step, as it provides concrete rules for prescribing the treatments.

Speaking with The American Journal of Managed Care^® regarding the 2018 American College of Cardiology (ACC) Expert Consensus Decision Pathway, Javed Butler, MD, a professor and chairman of the Department of Medicine at the University of Mississippi, discussed the treatments. “Guidelines across specialties have to be written and harmonized. This is a pet peeve of mine: cardiologists, and endocrinologists, primary care practitioners, pharmacists, nurse practitioners—whoever is going to be touching these patients—all have different guidelines…The bottom line is that we are all working with the same patient and using the same evidence. Problems arise when the team players are not on the same page,” he said.

The ADA endorsed the ACC pathway document, as the professional societies have worked in recent years to align recommendations for the treatment of patients with T2D and ASCVD.

Separate additions to the guidelines include updates to technological advances in treatment, expanded research on psychological impacts of the disease, and new recommendations regarding care of pregnant women with diabetes.

“The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge,” said the authors.

The ADA has updated the Standards of Medical Care in Diabetes every year since 1989, although the group now issues midyear updates for major clinical advances.