Carolyn J. Crandall, MD: Key Guideline Updates for Type 2 Diabetes

Carolyn J. Crandall, MD, MS, MACP

Credit: Marc Crandall

In this Q&A interview with the HCPLive editorial team, Carolyn J. Crandall, MD, MS, MACP, spoke on takeaways from her presentation ‘More News You Can Use: Current Clinical Guidelines in COVID-19 and Type 2 Diabetes.’ Over the course of the interview, Crandall highlighted several important elements of this talk

Crandall serves as professor of medicine at the David Geffen School of Medicine at UCLA and as chair of the American College of Physicians’ (ACP) clinical guidelines committee. In this interview, she highlighted updates to guidelines related to type 2 diabetes treatment.

HCPLive: What were the key updates or changes in clinical guidelines that you described for managing type 2 diabetes highlighted in your presentation to clinicians at the ACP Meeting?

Crandall: This guideline addressed the newer pharmacological agents that are available to treat Type 2 Diabetes. The ACP recommends adding a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or glucagon-like peptide-1 (GLP-1) agonist to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control.

We recommend using an SGLT-2 inhibitor to reduce risk for all-cause mortality, major adverse cardiovascular events, progression of chronic kidney disease, and hospitalization due to congestive heart failure. We recommend using a GLP-1 agonist to reduce the risk of all-cause mortality, major adverse cardiovascular events, and stroke.

ACP recommends against adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control to reduce morbidity and all-cause mortality.

HCPLive: In your view, how have the ACP guidelines evolved over time with regard to this particular topic?

Crandall: This new guideline is the first ACP guideline to evaluate these newer drugs: SGLT-2 inhibitors, GLP-2 agonists, long-acting insulin, tirzepatide, and DPP-4 inhibitors.

HCPLive: What do you hope healthcare professionals viewing your talk remember most from your presentation regarding type 2 diabetes management?

Crandall: It is important to go beyond glycemic control (that is, values of hemoglobin A1C) to evaluate the net clinical benefits of these newer treatments. Our guidelines carefully evaluated the effects of these medications on high-priority, important clinical outcomes, such as risk of death, major adverse cardiovascular events, progression of chronic kidney disease, hospitalization due to congestive heart failure, and stroke.

I believe this is a great strength of this guideline, as these are the important outcomes that persons with diabetes, and their physicians, deserve to know about. These important clinical outcomes, going beyond achieving the optimal level of hemoglobin A1C, are the outcomes that can really inform optimal decisions about diabetes drug therapy in persons whose diabetes is inadequately controlled despite metformin and lifestyle measures.

For further details on interviews with experts featured as presenters at the ACP conference, view the latest coverage from HCPLive.