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EASD Day 4 Highlights – Experts Explain Beyond A1C and New Joint ADA-EASD Care Guidelines for Adults with Type 2 Diabetes

By Jimmy McDermott, Emily Fitts, Ann Carracher, and Kelly Close

The benefits of measuring time in range, plus new care guidelines for adults with type 2 diabetes

The final day of the 2018 European Association for the Study of Diabetes brought insights on continuous glucose monitoring (CGM) and measuring time-in-range as an outcome beyond A1C. Additionally, a joint EASD-ADA Consensus Report was presented, with new guidelines for type 2 diabetes in adults. Stay tuned to hear more about our event in Berlin and see a more in-depth analysis of the EASD-ADA report. Also, check out all of our tweets from this year’s #EASD2018 on our Twitter page. Click to read more about these headlines from Berlin.

New Diabetes Care Guidelines from ADA and EASD for Adults with Type 2 Diabetes

The ADA-EASD Consensus Report draws on 479 published papers over the past four years to develop strategies for health care providers in treating adults with type 2 diabetes. The report focuses on an individual treatment plan considering health history, weight, heart and kidney health, costs of care, and individual preferences, which is a welcome emphasis on patient-centric care.

For the first time, the ADA-EASD Consensus Report provides specific drug recommendations based on an individual’s health profile and history. Notably, the new guidelines prefer GLP-1 agonists (Victoza, Ozempic, Bydureon, Trulicity) and SGLT-2 inhibitors (Jardiance, Farxiga, Invokana, Steglatro) over insulin after starting on metformin. Specifically:

  • SGLT-2 inhibitors are recommended for those with chronic kidney disease

  • For those with heart disease, either a GLP-1 agonist or SGLT-2 with proven heart benefits is recommended; Victoza and Jardiance have demonstrated the strongest heart benefits

  • GLP-1 agonists are recommended as the first injectable medication for most adults with type 2 diabetes

Although we would have liked to see a bigger focus on technology (particularly CGM), it is good to see that ADA and EASD are working together on individualizing diabetes treatment approaches.

Time-in-Range and Outcomes Beyond A1C

The Outcomes Beyond A1C movement was prominently featured at this year’s EASD. In particular, Professor Thomas Danne of the Diabetes Centre for Children and Adolescents in Germany advocated for a shift in the way we approach diabetes care – moving away from A1C and toward glucose variability. Unlike A1C, glucose variability captures what the daily experience of a person with diabetes is, while providing critical information for patients, health care providers, and regulators.

A key component of glucose variability is access to CGM, which enables patients and their health care providers to see a more complete picture of daily blood glucose fluctuations. Professor Danne argued that time-in-range (currently agreed upon as time spent between 70-180 mg/dl – read more here) is a more relevant measure than A1C, especially in distinguishing the time spent below range (i.e., in hypoglycemia). In fact, Professor Danne recommended that time-in-range be reported like blood pressure, with one number representing time-in-range and the other representing time-below-range (e.g., 54%/15%) to emphasize the importance of both measures.  

Read more about our work prompting the #BeyondA1C movement here.

Day 1 highlights here.

Day 2 highlights here

Day 3 highlights here