title: Is the ADA/EASD algorithm for the management of type 2 diabetes (January 2009) based on evidence or opinion? A critical analysis.
abstract: The ADA and the EASD recently published a consensus statement for the medical management of hyperglycaemia in patients with type 2 diabetes. The authors advocate initial treatment with metformin monotherapy and lifestyle modification, followed by addition of basal insulin or a sulfonylurea if glycaemic goals are not met (tier 1 recommendations). All other glucose-lowering therapies are relegated to a secondary (tier 2) status and only recommended for selected clinical settings. In our view, this algorithm does not offer physicians and patients the appropriate selection of options to individualise and optimise care with a view to sustained control of blood glucose and reduction both of diabetes complications and cardiovascular risk. This paper critically assesses the basis of the ADA/EASD algorithm and the resulting tiers of treatment options.
authors.affiliation: Department of Medicine I, Rudolfstiftung Hospital-Vienna, Juchgasse 25, 1030, Vienna, Austria. guntram.schernthaner@meduniwien.ac.at
authors.forename: G
authors.initials: G
authors.lastname: Schernthaner
authors.forename: A H
authors.initials: AH
authors.lastname: Barnett
authors.forename: D J
authors.initials: DJ
authors.lastname: Betteridge
authors.forename: R
authors.initials: R
authors.lastname: Carmena
authors.forename: A
authors.initials: A
authors.lastname: Ceriello
authors.forename: B
authors.initials: B
authors.lastname: Charbonnel
authors.forename: M
authors.initials: M
authors.lastname: Hanefeld
authors.forename: R
authors.initials: R
authors.lastname: Lehmann
authors.forename: M T
authors.initials: MT
authors.lastname: Malecki
authors.forename: R
authors.initials: R
authors.lastname: Nesto
authors.forename: V
authors.initials: V
authors.lastname: Pirags
authors.forename: A
authors.initials: A
authors.lastname: Scheen
authors.forename: J
authors.initials: J
authors.lastname: Seufert
authors.forename: A
authors.initials: A
authors.lastname: Sjohölm
authors.forename: A
authors.initials: A
authors.lastname: Tsatsoulis
authors.forename: R
authors.initials: R
authors.lastname: DeFronzo
mesh_terms: D000465:Algorithms; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D005060:Europe; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D012307:Risk Factors; D012955:Societies, Medical / Q000592:standards; D014481:United States
chemical_list: D007004:Hypoglycemic Agents