New diabetes treatment guidelines released

...the rising position of GLP-1·SGLT-2 drugs in the market

The Korea Diabetes Association discusses the new guidelines at its 2023 Annual Fall Conference

“GLP-1 analogues recommended before basal insulin when used in combination with injection therapy”

“SGLT-2 inhibitors to be used first when a patient has heart failure, regardless of HbA1c levels”

The status of GLP-1 analogues and SGLT-2 inhibitors has risen further in Korea’s new diabetes treatment guidelines.

 

In the revised guidelines, when considering options to use in combination with injection therapy, GLP-1 analogues were recommended over basal insulin, and SGLT-2 inhibitors were recommended first for diabetic patients with heart failure, kidney disease, or cardiovascular disease.

 

Kyu-Chang Won, Chairman of KDA (Endoctriology, Yeungnam University Hospital) is introducing KDA

On the 12th, Korean Diabetes Association introduced the key contents of its ‘KDA clinical practice guidelines for diabetes: 8th edition’ at the 2023 Spring Conference of the Korean Diabetes Association that was held at the Kimdaejung Convention Center in Gwangju.

 

The KDA publishes treatment guidelines for diabetes every 2 years.

 

The association organized a clinical practice guideline committee around Director Min Kyong Moon (Internal Medicine, Seoul National University Medical School) and developed the new practice guidelines from January last year to April this year.

 

The most notable change observed in the new guideline is the use of GLP-1 analogues and SGLT-2 inhibitors.

 

In general, the two classes of drugs were more strongly recommended.

 

GLP-1 analogues currently available in Korea include Trulicity (dulaglutide) and Ozempic (semaglutide), and SGLT-2 inhibitors include Forxiga (dapagliflozin) and Jardiance (dapagliflozin).

 

◆GLP-1 analogues = The new clinical practice guidelines ‘recommend GLP-1 analogues over basal insulin when considering injection-based combination therapy.’ Previously, treatments in combination with injection therapy were recommended as priority for potent blood sugar-lowering effect.

 

In addition, GLP-1 analogues in combination with basal insulin were recommended to enhance blood sugar control.

 

The newly revised guidelines went a step further from the previous guidelines to recommend GLP-1 analogues first.

 

Jung-Hyun Noh, professor of internal medicine at Inje University, said, “In a study that directly compared the results of using GLP-1 analogues+oral medications to separate use of GLP-1 analogues or insulin, there was no significant difference in their HbA1c level reduction effect.

 

However, the use of GLP-1 analogues was found to maintain the lowering effect longer.” In addition, the content that if the target blood sugar level cannot be achieved with either the GLP-1 analogue or basal insulin alone, the two drugs shall be used together, was newly added to the guideline.

 

It was also added that if the target blood sugar level is not reached even with GLP-1 analogue or basal insulin treatment, insulin potentiation therapy should be attempted.

 

◆SGLT-2 inhibitors = SGLT-2 inhibitors were also more strongly recommended.

 

The revised guideline recommends, "'in case of accompanying heart failure, the use of SGLT-2 inhibitors with proven heart failure benefits is recommended in priority regardless of HbA1c level, and the treatment should be continued unless contraindications or side effects arise.' In the case of renal disease as well, the revised guideline recommend 'in case of albuminuria or decreased estimated glomerular filtration rate, SGLT-2 inhibitors with proven renal benefits should be used first regardless of HbA1c level, and be maintained unless contraindications or side effects arise." Previous guidelines have recommended ‘treatment including SGLT-2 inhibitors to be considered first in patients with heart failure.’ Here, the phrase 'regardless of the HbA1c level’ was newly added with the revision.

 

Professor Noh said, “New studies have demonstrated the benefit of SGLT-2 inhibitors in heart failure and renal disease.

 

The effect was consistent in patients without diabetes.

 

This is why we recommended the use of SGLT-2 inhibitors if there is a risk of disease, regardless of HbA1c level." In addition, it was recommended that "treatment including GLP-1 analogues or SGLT-2 inhibitors with proven cardiovascular benefits should be prioritized in patients with atherosclerosis cardiovascular disease.

 

Previously, SGLT-2 inhibitors were recommended as monotherapy for such patients, but this time, GLP-1 analogues were added to the recommendations."