Diabetes Care has published an updated consensus algorithm for the initiation and adjustment of therapy to treat hyperglycaemia in type 2 diabetes. The American Diabetes Association and the European Association for the Study of Diabetes make the recommendations.
The algorithm was first published in 2006 with the expectation that it would be updated as new data and new interventions become available. This update places lifestyle and metformin as first line interventions with sulphonylureas and insulin recommended as second line agents. Strategies that are less well validated include pioglitazone, gliptins and triple therapy.
The recommendations particularly advise against using rosiglitazone stating that, "although the meta-analyses are not conclusive regarding the potential cardiovascular risk associated with rosiglitazone the consensus group members unanimously advised against using rosiglitazone".
Clinicians will already be well aware of the safety concerns linking rosiglitazone with heart attacks. Updated prescribing information advises against using rosiglitazone in specific patients including acute coronary syndrome and ischaemic heart disease.
Action: Clinicians should consider exclusively using familiar therapies that have a proven efficacy and safety record.