Italian guidelines for treatment of type 2 diabetes released

RECOMMENDATIONS

Treatment targets

• A target HbA1c between 49 mmol/mol (6.6%) and 58 mmol/mol (7.5%) is recommended for patients with type 2 diabetes treated with drugs capable of inducing hypoglycemia.
• A target HbA1c below 53 mmol/mol (7%) is recommended for patients with type 2 diabetes treated with drugs that are not capable of inducing hypoglycemia.
• A target HbA1c of 48 mmol/mol (6.5%) or lower is suggested for patients with type 2 diabetes treated with drugs which are not capable of inducing hypoglycemia.

Nutritional therapy

• Structured Medical Nutrition Therapy is suggested for the treatment of type 2 diabetes.
• A balanced (Mediterranean) diet is suggested, rather than a low-carbohydrate diet, for the treatment of type 2 diabetes.

Physical exercise

• Regular physical exercise is suggested for the treatment of type 2 diabetes.
• There is no evidence to prefer a threshold of 150 minutes per week for aerobic training in the treatment of type 2 diabetes.
• Combined (aerobic and resistance) training is suggested, rather than aerobic training alone, for the treatment of type 2 diabetes.

Educational therapy

• Structured educational therapy is suggested for the treatment of type 2 diabetes.
• Grouped-based educational programs are suggested, rather than individual, for the treatment of type 2 diabetes.

Pharmacological treatment

• The use of metformin is recommended as first-line long-term treatment in patients with type 2 diabetes, without previous cardiovascular events. SGLT-2 inhibitors or GLP-1 receptor agonists are recommended as second-line treatments. Pioglitazone, DPP-4 inhibitors, acarbose and insulin should be considered as third-line treatments
• The use of metformin, SGLT-2 inhibitors or GLP-1 receptor agonists is recommended as first-line long-term treatment in patients with type 2 diabetes with previous cardiovascular events and without heart failure. DPP-4 inhibitors, pioglitazone, acarbose and insulin should be considered as second-line treatments.
• The use of SGLT-2 inhibitors is recommended as first-line long-term treatment in patients with type 2 diabetes with previous heart failure. GLP-1 receptor agonists and metformin should be considered as second-line treatments. DPP-4 inhibitors, acarbose and insulin should be considered as third-line treatments.
• The use of basal insulin analogs is recommended, instead of NPH, for all patients with type 2 diabetes needing treatment with basal insulin.
• The use of prandial insulin analogs is suggested for patients with type 2 diabetes needing treatment with prandial insulin.
• The routine use of continuous subcutaneous insulin infusion in inadequately controlled patients with type 2 diabetes is not recommended.

Glycemic monitoring

• The authors suggest structure (with a pre-defined scheme of required tests) capillary blood glucose self-monitoring in the treatment of type 2 diabetes.
• Continuous glucose monitoring (continuous or on-demand) is not suggested rather than self-monitoring blood glucose in patients with type 2 diabetes on basal-bolus insulin therapy.

Reference:

Mannucci, E., Candido, R., Monache, L.d. et al. Italian guidelines for the treatment of type 2 diabetes. Acta Diabetol (2022). https://doi.org/10.1007/s00592-022-01857-4

KEYWORDS: type 2 diabetes, Acta Diabetologica, nutritional therapy, diabetes treatment, exercise, educational therapy, glycemic monitoring, blood sugar, HbA1c, hypoglycemia, Edoardo Mannucci, Mediterranean diet, diet, low carb diet, aerobic training, insulin