Recent studies and trials have influenced the management of diabetes in primary care, particularly in the areas of pharmacotherapy, lifestyle interventions, and quality improvement measures.
Pharmacotherapy
- The ADA 2024 guidelines suggest lower-cost medications for glycemic management such as metformin, sulfonylureas, thiazolidinediones, and human insulin in adult patients with diabetes and cost-related barriers, taking into account their risks for hypoglycemia, weight gain, cardiovascular and kidney events, and other adverse effects
- The guidelines also recommend including agents that reduce cardiovascular and kidney disease risk, such as SGLT-2 inhibitors and GLP-1 receptor agonists, in the treatment plan for glycemic management and comprehensive cardiovascular risk reduction in adult patients with T2DM and established or at high risk for ASCVD, HF, and/or CKD, regardless of HbA1c and in consideration of person-specific factors
- For the prevention of CVD, the ESC 2023 guidelines recommend initiating SGLT-2 inhibitors or GLP-1 receptor agonists to reduce cardiovascular risk in patients with T2DM without ASCVD or severe target-organ damage but with a calculated 10-year CVD risk ≥ 10%
Lifestyle interventions
- The ADA 2024 guidelines recommend intensifying lifestyle therapy and optimizing glycemic control in patients with elevated triglyceride levels (≥150 mg/dL) and/or low HDL-C (<40 mg/dL for males, <50 mg/dL for females)
- A study demonstrated the effectiveness of a pragmatic education program designed to promote walking activity in individuals with impaired glucose tolerance
- Another study showed that a single education and self-management structured program for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs
Quality improvement measures
- The ADA 2024 guidelines recommend aligning approaches to diabetes management with the Chronic Care Model, emphasizing person-centered team care, integrated long-term treatment approaches to diabetes and comorbidities, and ongoing collaborative communication and goal setting between all team members
- A study showed that diabetes care outcomes are better in primary care settings that use a patient-centered approach to systematically engage patients in decision making, remind physicians of age-appropriate risk assessments, and provide checklists for recommended diabetes interventions
In conclusion, the integration of newer pharmacological agents, advanced glucose monitoring technologies, and personalized lifestyle interventions are shaping the contemporary management of diabetes in primary care.