World Health Organization Guidelines on Medicines for Diabetes Treatment Intensification: Commentary From the American College of Physicians High Value Care Committee
Authors: Linda L. Humphrey, Devan Kansagara, Amir Qaseem
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions18 September 2018World Health Organization Guidelines on Medicines for Diabetes Treatment Intensification: Commentary From the American College of Physicians High Value Care CommitteeLinda L. Humphrey, MD, MPH, Devan Kansagara, MD, MCR, and Amir Qaseem, MD, PhD, MHA, for the High Value Care Committee of the American College of Physicians*Linda L. Humphrey, MD, MPHOregon Health & Science University, Portland, Oregon (L.L.H.), Devan Kansagara, MD, MCROregon Health & Science University and Veterans Affairs Medical Center, Portland, Oregon (D.K.), and Amir Qaseem, MD, PhD, MHAAmerican College of Physicians, Philadelphia, Pennsylvania (A.Q.), for the High Value Care Committee of the American College of Physicians*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1148 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail More than 400 million adults worldwide are living with diabetes, and the World Health Organization (WHO) should be commended for its leadership in combating the global epidemic. The recent WHO guideline on managing diabetes mellitus contains important considerations, including evidence about benefits and harms of medications, intervention costs, and application to resource-poor settings (1, 2). The guideline reinforces several others—including the American College of Physicians (ACP) guideline (3)—and highlights the importance of lifestyle changes in managing diabetes and the use of metformin as the best first-line pharmacologic therapy for most patients with type 2 diabetes. We focus here on the ...References1. World Health Organization. Guidelines on second- and third-line medicines and type of insulin for the control of blood glucose levels in non-pregnant adults with diabetes mellitus. 2018. Accessed at www.who.int/diabetes/publications/guidelines-diabetes-medicines/en on 11 July 2018. Google Scholar2. Roglic G, Norris SL; World Health Organization. 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Storgaard H, Gluud LL, Bennett C, Grøndahl MF, Christensen MB, Knop FK, et al. Benefits and harms of sodium-glucose co-transporter 2 inhibitors in patients with type 2 diabetes: a systematic review and meta-analysis. PLoS One. 2016;11:e0166125. [PMID: 27835680] doi:10.1371/journal.pone.0166125 CrossrefMedlineGoogle Scholar9. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al; LEADER Steering Committee. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311-22. [PMID: 27295427] doi:10.1056/NEJMoa1603827 CrossrefMedlineGoogle Scholar10. Mann JFE, Ørsted DD, Brown-Frandsen K, Marso SP, Poulter NR, Rasmussen S, et al; LEADER Steering Committee and Investigators. Liraglutide and renal outcomes in type 2 diabetes. N Engl J Med. 2017;377:839-48. [PMID: 28854085] doi:10.1056/NEJMoa1616011 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Oregon Health & Science University, Portland, Oregon (L.L.H.)Oregon Health & Science University and Veterans Affairs Medical Center, Portland, Oregon (D.K.)American College of Physicians, Philadelphia, Pennsylvania (A.Q.)Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official position of the ACP.Financial Support: Financial support for the development of this commentary comes exclusively from the ACP operating budget.Disclosures: All financial and intellectual disclosures of interest were declared and potential conflicts were discussed and managed. Dr. Abraham was recused from voting for a financial conflict. A record of disclosures of interest is kept for each High Value Care Committee meeting and conference call and can be viewed at www.acponline.org/clinical-information/high-value-care. Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1148.Corresponding Author: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, [email protected]org.Current Author Addresses: Drs. Humphrey and Kansagara: 3710 Southwest U.S. Veterans Hospital Road, Portland, OR 97201.Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.Author Contributions: Conception and design: D. Kansagara, A. Qaseem.Analysis and interpretation of the data: L.L. Humphrey, D. Kansagara.Drafting of the article: L.L. Humphrey, D. Kansagara, A. Qaseem.Critical revision for important intellectual content: L.L. Humphrey, D. Kansagara, A. Qaseem.Final approval of the article: L.L. Humphrey, D. Kansagara, A. Qaseem.Statistical expertise: A. Qaseem.Administrative, technical, or logistic support: A. Qaseem.Collection and assembly of data: L.L. Humphrey, D. Kansagara.This article was published at Annals.org on 4 September 2018.* Individuals who served on the High Value Care Committee were Amir Qaseem, MD, PhD, MHA† (Chair); George M. Abraham, MD, MPH‡; Robert Centor, MD†; Douglas M. DeLong, MD†; Heather E. Gantzer, MD†; Carrie A. Horwitch, MD, MPH†; Linda L. Humphrey, MD, MPH†; Janet A. Jokela, MD, MPH†; Joseph Ming Wah Li, MD†; Robert H. Lohr, MD†; Ana María López, MD, MPH†; and Robert M. McLean, MD†.† Author.‡ Nonauthor contributor. 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Humphrey, MD, MPH, and Amir Qaseem, MD, PhD, MHA 18 September 2018Volume 169, Issue 6Page: 398-400KeywordsDecision makingDisclosureGlobal healthGlucoseHemoglobinHypoglycemiaInsulinSafetyTreatment guidelinesType 2 diabetes ePublished: 4 September 2018 Issue Published: 18 September 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...