1. Riktlinjer Behandling av typ 2 diabetes Växjö 2019-02-13
Maria Thunander
Överläkare, med dr
Medicinkliniken, Centrallasarettet Växjö
FoU, Region Kronoberg
Institutionen för Klin Vetenskaper, Lunds Universitet

2. Clinical Inertia Vi väntar för länge med att intensifiera terapin!
EASD MT

3. Att vänta påverkar möjlighet nå glykemiskt mål:
EASD MT

4. Glukossänkande terapi T2D Sverige 2006-2013
Svensk studie fr läkemedelsregistret

5. Aktuellt vid typ 2 diabetes
Framför allt: Nya behandlingsrekommendationer !
Gemensamma för EASD och ADA
Europa och USA
Kommer när till Sverige? – dock redan relativt anpassade svenska RL
GLP1-RA och SGLT-2 rek FÖRE SU och insulin

6. ”
The most recent press releases from the American Diabetes Association: October 5,  urklipp New Consensus Report from the American Diabetes Association® (ADA) and the European Association for the Study of Diabetes (EASD) Calls for Paradigm Shift to Patient-Centered Care for Type 2 Diabetes Produced by an international panel of diabetes care experts assembled by the ADA and the EASD, the ADA-EASD Consensus Report calls for a paradigm shift to patient-centered care and details the panel’s comprehensive review of the latest evidence.”

7. Management of Hyperglycemia in Type 2 Diabetes, 2018: A Consensus Report by the American Diabetes Association and the European Association for the Study of Diabetes (ADA-EASD Consensus Report).
Nya “roadmaps” (algorithms)
to help achieve optimal diabetes control and
improved quality of life
jointly produced and presented by EASD and ADA
produced by an international panel of diabetes care experts
the ADA-EASD Consensus Report calls for a paradigm shift
to patient-centered care
comprehensive review of the latest evidence.
simultaneously published 5 oct in Diabetes Care, and Diabetologia.

8. Nya behandlingsriktlinjer för Typ 2 diabetes Gränsövergång
Metformin fortfarande förstahandsval.
Första injektionsläkemedel bör ej vara insulin, utan GLP1-RA
Andrahandsval utifrån patientens situation och behov
Njurfunktion, hjärta, hypoglykemirisk, vikt, preferenser, förmåga
SU endast om ekonomi är viktig fråga (”ej i Europa och Canada”)

9. Management of hyperglycaemia in type 2 diabetes, 2018
Management of hyperglycaemia in type 2 diabetes, A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
An individualised programme of MNT should be offered to all patients. - Mat
All overweight and obese patients with diabetes should be advised of the health benefits of weight loss and encouraged to engage in a programme of intensive lifestyle management, which may include food substitution
Increasing physical activity improves glycaemic control and should be encouraged in all people with type 2 diabetes.
EASD MT

10. Decision cycle for patient-centered glycaemic management in type 2 diabetes
EASD MT

11. Glucose-lowering medication in type 2 diabetes: overall approach
EASD MT

12. Management of hyperglycaemia in type 2 diabetes, 2018
Management of hyperglycaemia in type 2 diabetes, A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
Providers and healthcare systems should prioritize the delivery of patient-centred care.
Facilitating medication adherence should be specifically considered when selecting glucose-lowering medications.
Among patients with type 2 diabetes who have established ASCVD, SGLT2 inhibitors or GLP-1 receptor agonists with proven cardiovascular benefit are recommended as part of glycaemic management.
EASD MT

13. T2D and Established Atherosclerotic Cardiovascular disease (ASCVD) or Chronic Kidney Disease (CKD)
EASD MT

14. Management of hyperglycaemia in type 2 diabetes, 2018
Management of hyperglycaemia in type 2 diabetes, A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
"What's new since 2015 is we recommend that these comorbidities be considered first and foremost, ……...
Within the classes, preference is given to liraglutide among GLP-1 receptor agonists based on the LEADER trial, and empagliflozin among SGLT2 inhibitors based on EMPA-REG OUTCOME.
EASD MT

15. Management of hyperglycaemia in type 2 diabetes, 2018
Management of hyperglycaemia in type 2 diabetes, A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Hjärtsvikt och njurpåverkan:
Among patients with ASCVD in whom HF coexists or is of special concern, SGLT2 inhibitors are recommended.
For patients with type 2 diabetes and CKD, with or without CVD, consider the use of an SGLT2 inhibitor shown to reduce CKD progression or, if contraindicated or not preferred, a GLP-1 receptor agonist shown to reduce CKD progression
Patients with type 2 diabetes and kidney disease are at an increased risk for cardiovascular events.
A substantial number of participants with an eGFR of 30–60 mlmin−1[1.73m]−2were included in EMPA-REG OUTCOME, CANVAS, LEADER and SUSTAIN6. An important finding in the studies was reduction of the primary ASCVD outcome even among participants with stage 3 CKD (eGFR 30–60 ml min−1 [1.73 m]−2). For SGLT2inhibitors, this contrasts with the glucose-lowering effect, which diminishes with declining eGFR.
EASD MT

16. Minimize weight gain or promote weight loss
EASD MT

17. Consensus recommendation:
Management of hyperglycaemia in type 2 diabetes, A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
Consensus recommendation:
Metabolic surgery is a recommended treatment option for adults with type 2 diabetes and
(1) a BMI ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in people of Asian ancestry) or
(2) a BMI of 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in people of Asian ancestry) who do not achieve durable weight loss and improvement in comorbidities with reasonable non-surgical methods.
EASD MT

18. Management of hyperglycaemia in type 2 diabetes, 2018
Management of hyperglycaemia in type 2 diabetes, A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
Intensification of treatment beyond dual therapy to maintain glycaemic targets requires consideration of the impact of medication side effects on comorbidities, as well as the burden of treatment and cost.
In patients who need the greater glucose-lowering effect of an injectable medication, GLP-1 receptor agonists are the preferred choice to insulin. For patients with extreme and symptomatic hyperglycaemia, insulin is recommended.
EASD MT

19. Minimera hypoglykemi
EASD MT

20. Intensifiering av injektions-terapi
EASD MT

21. Tabletter i kombination med injektionsterapi
EASD MT

22. Management of hyperglycaemia in type 2 diabetes, 2018
Management of hyperglycaemia in type 2 diabetes, A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
Patients who are unable to maintain glycaemic targets on basal insulin in combination with oral medications can have treatment intensified with GLP-1 receptor agonists, SGLT2 inhibitors or prandial insulin.
Access, treatment cost and insurance coverage should all be considered when selecting glucose-lowering medications.
EASD MT

23. Om kostnad är avgörande
EASD MT

24. Management of hyperglycaemia in type 2 diabetes, 2018
Management of hyperglycaemia in type 2 diabetes, A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
"The focus of this consensus report is not on what an individual's glycemic target should be or on how to select individualized goals, but rather how to achieve the individual patients' glycemic target taking into account patient factors and the ever-increasing choice of therapies available for glycemic control,"
EASD MT

25. Läkartidningen 2018 Nyström och Nathanson

26. Kronoberg , primärvård, Typ 2
Okt 2018