Medicines for Treatment Intensification in Type 2 Diabetes and Type of Insulin in Type 1 and Type 2 Diabetes in Low-Resource Settings: Synopsis of the World Health Organization Guidelines on Second- and Third-Line Medicines and Type of Insulin for the Control of Blood Glucose Levels in Nonpregnant Adults With Diabetes Mellitus

• DOI: 10.7326/m18-1149
• Publication Date: 2018-09-03T22:32:29Z
• Authors: Gojka Roglic; Susan L. Norris
• Keywords: Adult; Blood Glucose; Dipeptidyl-Peptidase IV Inhibitors; Developed Countries; Contraindications, Drug; 16. Peace & justice; World Health Organization; Metformin; 3. Good health; 03 medical and health sciences; Diabetes Mellitus, Type 1; Sulfonylurea Compounds; 0302 clinical medicine; Diabetes Mellitus, Type 2; 13. Climate action; Health Resources; Humans; Hypoglycemic Agents; Insulin; Thiazolidinediones; Developing Countries; Sodium-Glucose Transporter 2 Inhibitors

The World Health Organization developed these guidelines to provide guidance on selection of medicines for treatment intensification in type 2 diabetes and use insulin (human or analogue) 1 diabetes. target audience includes clinicians, policymakers, national program managers, medicine procurement officers. population is adults with low-resource settings low- high-income countries. also apply disadvantaged populations countries.The recommendations were formulated by a 12-member guideline development group are based high-quality systematic reviews identified via search several bibliographic databases from January 2007 March 2017. GRADE (Grading Recommendations Assessment, Development Evaluation) system was used assess the quality evidence strength recommendations. peer-reviewed 6 external reviewers.Give sulfonylurea patients who do not achieve glycemic control metformin alone have contraindications (strong recommendation, moderate-quality evidence).Introduce human and/or very-low-quality evidence).If unsuitable, dipeptidyl peptidase-4 (DPP-4) inhibitor, sodium-glucose cotransporter-2 (SGLT-2) thiazolidinedione (TZD) may be added (weak evidence).Use manage blood glucose whom indicated low-quality evidence).Consider long-acting analogues frequent severe hypoglycemia hypoglycemia).