Guidelines for early treatment

This website isn’t supported by Internet Explorer. We recommend that you use a different browser (e.g. Edge, Chrome, Firefox, Safari, or similar) for the best experience of our content.

When it comes to type 2 diabetes, more options are available than ever before to help your patients manage their disease and reduce the risk of future complications.

Guidelines recommend timely and optimised treatment to reduce complications and maintain quality of life.¹

In this video we will be looking at the latest updates to the 2022 consensus report by the ADA and EASD. The report reinforces the four cornerstones of holistic diabetes management: glycaemic control, CV risk factor management, weight management and cardiorenal protection.

Importantly, the consensus report now opens for the possibility of utilizing other agents, beyond metformin, as first-line therapies to achieve adequate efficacy and achieve & maintain treatment goals.

For more videos and other educational materials, visit the Resources page

Every person living with type 2 diabetes has individualised needs, such as comorbidities and clinical characteristics, which are important to take into consideration.^1,2 Below is a quick guide to take you through the first decisions in the management of your patients.

Lifestyle management, including physical activity and healthy diet, is the cornerstone in the treatment of type 2 diabetes. The 2022 guidelines from ADA and EASD highlight nutrition therapy, physical activity behaviors, and sleep to carry distinct impact as first-line tools in improving health outcomes for people living with diabetes.¹

Supporting healthy eating patterns is fundamental in diabetes treatment, with management of dietary quality and energy restriction being core dimensions for improving glycemic control.

Applying a person-centered approach to identify healthy dietary habits can help patients achieve a new energy deficit, leading to weight loss and additional health benefits.¹

Significant improvements to HbA_1c and cardiometabolic health can be achieved by increasing physical activity level.

Patients should be encouraged to ≥150 min of moderate-intensity physical activity or ≥75 min vigorous-intensity activity per week, but an increase of as little as 500 steps a day can decrease the all-cause mortality rates and risk of cardiovascular morbidity with 2-9%.¹

People living with type 2 diabetes often suffer from sleep disorders, which are associated with an increased risk of obesity and impairments in daily functioning. Studies show that more than half of people living with type 2 diabetes are affected by obstructive sleep apnea, which is associated with blood glucose levels.¹

Empower your patients to look at food in new ways. Here are 3 methods that can help establish healthy and maintainable eating habits.

Are your patients looking for inspiration to manage their diabetes through exercise? These useful tips on how to get moving might help your patients’ set realistic goals.

Good quality sleep improves general health and well-being for people with diabetes.¹ This guide may help your patients improve their bedtime routine.

Still not under control?

Scroll down to see recommendations for glucose-lowering medications when patients are not controlled through diet and exercise management.

Still not under control?

Scroll down to see recommendations for glucose-lowering medications when patients are not controlled through diet and exercise management.

According to the ADA and EASD 2022 consensus report, a greater emphasis should be applied to weight management as part of a holistic approach to treating diabetes. Weight loss of 5-15% should be considered as a primary target for many people living with type 2 diabetes.¹

Besides lifestyle management, the consensus report recommends earlier use of a glucose-lowering therapy, and considering weight loss medication or metabolic surgery.¹

When choosing a treatment for achievement and maintenance of weight management goals, consider a regimen with high–very high dual glucose and weight efficacy.¹

*with proven weight loss according to label indication

*GLP1 RAs other than semaglutide, tirzepatide, liraglutide and dulaglutide

Oral tablet or injection

Mode of action: Increases insulin release when blood glucose increases, reduces glucose release from the liver, delays gastric emptying and increases satiety
Beneficial characteristics: Promotes weight loss, proven CV benefits (*)
Common side-effects: Gastrointestinal such as nausea and diarrhea
Caution: Not suited for patients with previous pancreatitis

*according to label indication

Oral tablet

Mode of action: Increasing glucose excretion in the urine by preventing reabsorption of glucose from the kidneys
Beneficial characteristics: Reduced blood pressure and weight loss, proven CV benefits (*)
Common side-effects: Urinary and genital infections
Caution: May not be suited for patients with kidney disease

*according to label indication

^{For agent-specific recommendations, please refer to the manufacturers’ prescribing information.}

^{CV: Cardiovascular; DPP-4i: Dipeptidyl peptidase 4 inhibitor; GLP-1 RA: Glucagon-like peptide-1 receptor agonist; HDL: High-density lipoprotein; SGLT2i: Sodium-glucose cotransporter 2 inhibitor; SU: Sulfonylureas; TZD: Thiazolidinediones.}

The management approach to type 2 diabetes should take account of its life-long nature and complexity. Choosing the best glucose-lowering therapy for your patient may depend on a variety of factors, such as cardiometabolic risk profile, and should always be holistic and person-centered.¹

Traditional recommendations focused on a step-wise approach. However, the latest consensus report supports earlier use of monotherapies or combination therapies that address additional cardiometabolic risk factors beyond diabetes.¹

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in people with type 2 diabetes. Therefore, an important early step is to consider the presence or absence of ASCVD, where diabetes treatments with proven benefits on morbidity and mortality should be considered.³

If ASCVD predominates, a GLP-1 RA or SGLT2i (if eGFR adequate) with proven benefits should be considered.^1,2

If HbA_1c remains above target, for patients on SGLT2i, consider incorporating a GLP-1 RA with proven CV benefit or vice versa.¹

*with proven CVD benefits according to label indication

** with proven HF/CKD benefits according to label indication

Oral tablet or injection

Mode of action: Increases insulin release when blood glucose increases, reduces glucose release from the liver, delays gastric emptying and increases satiety
Beneficial characteristics: Promotes weight loss, proven CV benefits(*)
Common side-effects: Gastrointestinal such as nausea and diarrhea
Caution: Not suited for patients with previous pancreatitis

*according to label indication

Oral tablet

Mode of action: Increasing glucose excretion in the urine by preventing reabsorption of glucose from the kidneys
Beneficial characteristics: Reduced blood pressure and weight loss, proven CV benefits(*)
Common side-effects: Urinary and genital infections
Caution: May not be suited for patients with kidney disease

*according to label indication

^{For agent-specific recommendations, please refer to the manufacturers’ prescribing information.}

^{CKD: Chronic kidney disease; CV: Cardiovascular; HF: Heart failure; GLP-1 RA: Glucagon-like peptide-1 receptor agonist; SGLT2i: Sodium-glucose cotransporter 2 inhibitor.}

If your patients are in need for further intensification following 2nd-line therapy, or if you'd like to understand the underlying rationale for the decisions and guidance for the management of type 2 diabetes, please refer to the EASD/ADA consensus report.

Learn more about GLP-1 RA as a second-line treatment for people living with type 2 diabetes.

Making the best choice for your patient means tackling type 2 diabetes from different angles. Explore the patient cases to see which patients could benefit from a Shift?

Davies MJ, Aroda VR, Collins BS, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022 Nov 1;45(11):2753-2786.

Buse JB, Wexler D, Tsapas A et al. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43(2):487-493.

Mosenzon O, Alguwaihes A , Leon JLA et al. CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries. Cardiovasc Diabetol. 2021 Jul 27;20(1):154.

The information contained in this site is intended for healthcare professionals only outside of the United States of America. This site is not intended to provide medical advice and/or treatment guidance. Only a physician can determine whether a specific product is correct for a particular patient. This site is not country-specific and therefore may contain information which is not applicable to your country. Novo Nordisk accepts no liability for the accuracy, completeness or use of this information, and disclaims any liability to update the information contained on this site. By accessing this site and materials you accept this legal notice and expressly confirm your status as a healthcare professional. Any images shown are models and not real patients.

HQ24DI00139, April 2024

For healthcare professionals only