Italian guidelines for treatment of type 2 diabetes released
Italy: A recent study, published in the journal Acta Diabetologica has reported Italian guidelines for the treatment of type 2 diabetes. The guideline is directed to physicians, dietitians, nurses, and educators working in diabetes specialist clinics; general practitioners; nurses and dietitians working in territorial services or private offices; and patients with diabetes.
The guideline was developed by Edoardo Mannucci, University of Florence, Largo Brambilla, Florence, Italy, and colleagues with an objective to provide a reference for the pharmacological and non-pharmacological treatment of type 2 diabetes in adults.
The guideline contains recommendations on the following clinical aspects of type 2 diabetes: 1) treatment targets; 2) nutritional therapy; 3) physical exercise; 4) educational therapy; 5) pharmacological treatment (for patients with and without previous cardiovascular disease), and 6) glycemic monitoring.
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
