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Ali Asghar Bhutto
Rashid Ali
Ibrahim Marouf Yasin Al Shyyab
Moiz Ali
Ermias Girma Tsega
Indrani Paul



Background: The management of diabetes poses challenges due to the array of available medications and the absence of comprehensive comparative trials. To address this, the Spanish Diabetes Society commissioned a Working Group to create a dynamic document tailored to national context.

Objective: The document emphasizes individualized treatment decisions by healthcare providers, considering patient characteristics and treatment safety. Regular updates ensure alignment with evolving evidence and expert insights.

Key Aspects:

  1. Goals of Control: Initial treatment typically involves lifestyle modifications and metformin. For patients with HbA1c above 8.5%, insulin therapy may be initiated, possibly in combination with oral medications. Stepwise adjustments and close monitoring are essential to optimize patient outcomes and minimize complications.

  2. Inertia Therapy: Monitoring metabolic control, tolerance to treatment, and associated complications are crucial after therapy initiation. Regular reassessment and adjustments are necessary to maintain optimal control.

  3. Staggered Therapeutic Approaches: Medication choice is influenced by factors such as HbA1c levels, risk of hypoglycemia, and patient characteristics. Various alternatives to metformin, including sulfonylureas, DPP-4 inhibitors, glinides, thiazolidinediones, and basal insulin, are considered based on individual patient responses.

  4. Combination Therapies: Combinations of medications, such as metformin with sulfonylureas, DPP-4 inhibitors, or GLP-1 receptor agonists, are explored for efficacy and safety. Insulin therapy is considered in cases of poor metabolic control or intolerance to oral medications.

  5. Treatment Algorithms: Algorithms guide the sequential addition of medications based on patient response, aiming to achieve optimal metabolic control while minimizing adverse effects.

Conclusion: The comprehensive framework outlined in the document aims to guide clinicians in navigating the complexities of diabetes management. It emphasizes individualized treatment approaches tailored to patient needs and safety considerations, with regular updates to reflect evolving evidence and expert consensus.


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