HealthDay News — The American College of Physicians (ACP) has updated recommendations on the oral pharmacologic treatment of type 2 diabetes in adults. The clinical practice guideline update was published online Jan 3 in the Annals of Internal Medicine.

Amir Qaseem, MD, PhD, from the ACP in Philadelphia, and colleagues developed guidelines relating to oral pharmacologic treatment of type 2 diabetes in adults. They conducted a systematic review of randomized controlled trials and observational studies on the comparative effectiveness of oral medications for type 2 diabetes. The interventions assessed included metformin, thiazolidinediones, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors.

The ACP recommends that clinicians prescribe metformin when pharmacologic therapy is needed to improve glycemic control (strong recommendation; moderate-quality evidence). When a second oral therapy is considered in order to improve glycemic control, clinicians should consider adding a sulfonylurea, thiazolidinedione, SLGT-2 inhibitor, or a DPP-4 inhibitor to metformin (weak recommendation; moderate-quality evidence). After discussing benefits, adverse effects, and costs, clinicians and patients should select among medications.

“The ACP developed this guideline to present the evidence and provide clinical recommendations on oral pharmacologic treatment of type 2 diabetes in adults,” the authors write. “This guideline serves as an update to the 2012 ACP guideline on the same topic.”

One author disclosed financial ties to Informed Medical Decisions Foundation and Healthwise, both nonprofits.

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  1. Qaseem A, Humphrey LL, Sweet DE, et al. Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 3 January 2017. doi: 10.7326/0003-4819-156-3-201202070-00011.