‘Diabetes management needs to be quicker, stronger, extra thorough’

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Korea’s newly updated guidelines for treating diabetes say doctors should screen diabetes faster, restore blood sugar levels more effectively, and control blood sugar levels more thoroughly.

The Korean Diabetes Association published the Diabetes Treatment Guideline 2021 at its 34th Spring Conference and the 5th Korea-Japan Diabetes Forum on Friday. In addition, the KDA has published a separate summary of the guideline on its website to help clinicians educate patients and manage diabetes systematically.

The Korean Diabetes Association released the Diabetes 2021 Treatment Guideline on Friday.

The KDA divided the level of evidence of the treatment guidelines based on the study design. In addition, the recommendation level has been divided into two categories: general recommendation and restricted recommendation.

The KDA emphasized the importance of screening to find those who are most likely to be diagnosed with diabetes early on.

Because patients with type 2 diabetes without particular symptoms often miss the diagnosis, the latest guideline includes the screening criteria and testing methods for high-risk diabetics based on the results of the most recent local clinical studies.

Accordingly, the guidelines of the KDA also recommended that an oral glucose tolerance test for adults with a fasting blood sugar level of 100-109 mg / dl and a body mass index (BMI) of 23 kg / m2 or more be considered.

Oral drugs and injections in antidiabetic drugs were also integrated in the guidelines and drugs based on blood sugar control and the presence of comorbidities were recommended separately.

In particular, when choosing a drug for type 2 diabetes patients, a doctor should generally consider the blood sugar lowering effect, the risk of hypoglycaemia, side effects, concomitant diseases (heart failure, atherosclerotic cardiovascular diseases, chronic kidney diseases), the acceptability of the treatment and the age consider. the value of the life the patient is pursuing and the cost.

The guidelines maintained the rationale of using and maintaining metformin first unless there is a side effect or contraindication. However, to reduce the risk of blood sugar failure, the KDA also recommended active use of combination therapy at the start of treatment or injection therapy to lower blood sugar levels significantly.

If patients with heart failure are associated, doctors should first consider using an SGLT-2 inhibitor with proven cardiovascular benefits, the guidelines say.

For those associated with atherosclerotic cardiovascular disease, doctors should first consider an SGLT-2 inhibitor with proven cardiovascular benefits or a GLP-1 receptor agonist for combination therapy, as recommended by the KDA. For patients with excessive urinary albumin or a reduced glomerular filtration rate, the guidelines recommended an SGLT2 inhibitor with proven cardiovascular and renal benefits, also as monotherapy.

The KDA also encouraged clinicians to use internationally standardized continuous glucose monitors (CGM) and ambulatory blood glucose control programs to help patients control their glucose levels more closely.

Treatment guidelines re-added the contents of CGM and insulin pumps and recommended the use of a CGM in type 1 diabetes patients and type 1 diabetes pregnant women. Regular use of a CGM is also recommended for type 2 diabetes as needed.

The goal of lifestyle correction based on BMI to prevent type 2 diabetes was also described in the new guidelines. In order to correct and maintain lifestyle, the guidelines recommended the use of various tools, including ICT technology.

Obese diabetics are advised to lose at least 5 percent of their basic weight by adjusting their lifestyle. However, those who have failed can get obesity treatment, the guidelines say.

Type 2 diabetes patients with a BMI of 30 kg / m2 or greater may consider obesity surgery if they cannot lose weight and control glucose through nonsurgical treatment, the KDA added.