Nathan DM, Buse JB, Davidson MB et al.
Massachusetts General Hospital, Boston, MA, USA.
Diabetes Care 2009;32:193–203.
[2] Medical management of hyperglycemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes.
Nathan DM, Buse JB, Davidson MB et al.
Massachusetts General Hospital, Boston, MA, USA.
Diabetologia 2009;52:17–30.
Editor’s note: This statement, published simultaneously in
Diabetes Care and
Diabetologia, is in essence an update of the previous American Diabetes Association/European Association for the Study of Diabetes consensus statement on the medical management of hyperglycemia in type 2 diabetes patients published in 2006 (
Diabetes Care 2006;29:1963–72) [1,2]. In principle, the aim of this document (like the updated National Institute for Health and Clinical Excellence guidelines for type 2 diabetes) was to review the use of some of the newer agents for type 2 diabetes treatment. In reality, the guidance in this statement is highly conservative in this respect, with primacy being given to metformin and sulfonylurea or metformin and insulin combinations as the best evidence-based intervention for step 2. In this context, and given the split evidence on the matter, these guidelines appear to be significantly biased towards the use of a basal plus insulin regimen rather than pre-mixed insulins, which will undoubtedly disturb clinicians who use the latter extensively. The thiazolidinedione group is represented almost exclusively in these guidelines by pioglitazone, with an avoidance recommendation for rosiglitazone (which may or may not be evidence based). However, the principles of glycemic management are well described by a group of clinicians with a huge wealth of experience between them and, therefore, make important reading for anybody involved in the care of people with type 2 diabetes.