American Diabetes Association, European Association for the Study of Diabetes Publish Consensus Algorithm for Type 2 Diabetes Treatment

October 22, 2008

A panel of experts convened by the American Diabetes Association and the European Association for the Study of Diabetes has issued updated treatment recommendations for type 2 diabetes, in a consensus statement being published online today in the journals Diabetes Care and Diabetologia.

The revisions to the diabetes treatment algorithm, first published in 2006, provide guidance to health care providers for treating type 2 diabetes, taking into account new medications that have come on the market and the most current scientific data regarding previously recommended drugs.

The algorithm describes a stepped-care approach to treat the elevated levels of blood glucose and A1C, a measure of average glucose levels during the previous two to three months that characterize diabetes. The consensus statement authors again suggest lifestyle changes and metformin as the initial treatment to help people newly diagnosed with type 2 diabetes achieve A1C goals. The lifestyle intervention and metformin are usually continued throughout the treatment course. However, if glucose/glycemic goals are not met, or not maintained over time, the algorithm progresses to Step 2 and provides two choices. The first choice, which is preferred and well validated, calls for the addition of basal insulin or a sulfonylurea to lifestyle changes and metformin. The second choice includes the addition of pioglitazone or a GLP-1 agonist to lifestyle changes and metformin. If the Step 2 choices do not maintain A1C goals, the panel suggests initiation of basal insulin, if not already started, and then transition to intensive insulin (Step 3), if needed. As in the original algorithm, all of the transitions in therapy usually occur at 3-month intervals, aiming for rapid achievement and continuous maintenance of near-normal glucose and A1C levels.

"Excellent glycemic control is critical to prevent the long-term complications associated with diabetes, which can lead to loss of vision, kidney failure, and amputations," said Dr. David M. Nathan, Chair of the Panel. "After much deliberation, we intentionally chose therapies we highly recommend as safe, effective, and that have much evidence supporting their use. The second tier drugs are valuable if hypoglycemia is a major concern, but the use of these drugs is less validated."

For interviews with Dr. Nathan, please e-mail him at

Prof. Ele Ferrannini, Past President of EASD, said, "This joint EASD/ADA statement on the treatment of type 2 diabetes is an effort to represent the latest scientific evidence relevant to the use of blood glucose lowering agents in the hope of providing comprehensive guidance to clinicians."

For interviews with Prof. Ferrannini, please e-mail

About the American Diabetes Association

Nearly half of American adults have diabetes or prediabetes; more than 30 million adults and children have diabetes; and every 21 seconds, another individual is diagnosed with diabetes in the U.S. Founded in 1940, the American Diabetes Association (ADA) is the nation’s leading voluntary health organization whose mission is to prevent and cure diabetes, and to improve the lives of all people affected by diabetes. The ADA drives discovery by funding research to treat, manage and prevent all types of diabetes, as well as to search for cures; raises voice to the urgency of the diabetes epidemic; and works to safeguard policies and programs that protect people with diabetes. In addition, the ADA supports people living with diabetes, those at risk of developing diabetes, and the health care professionals who serve them through information and programs that can improve health outcomes and quality of life. For more information, please call the ADA at 1-800-DIABETES (1-800-342-2383) or visit Information from both of these sources is available in English and Spanish. Find us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn)