The World Health Organization (WHO) released new recommendations earlier this week about which medicines should be used for treatment in adult patients with Type 1 and Type 2 diabetes.
The recommendations, published in the Annals of Internal medicine by Dr. Rojka Roglic and Dr. Susan Norris, targets adults with Type 1 or Type 2 diabetes in low-resource settings in low- or high-income countries. The guidelines also apply to disadvantaged populations in high-income countries.
It’s the first update to WHO diabetes guidelines since 2013.
The new guidelines specifically address treatment intensification after metformin in Type 2 diabetes and use of insulin in Type 1 and Type 2 diabetes.
The recommendations state the following guidelines:
- Prescribe a sulfonylurea to patients with Type 2 diabetes who have contraindications to metformin or do not reach glycemic control with metformin alone.
- Introduce human insulin treatment to patients with Type 2 diabetes who do not reach glycemic control with a sulfonylurea and/or metformin.
- If insulin is unsuitable, a thiazolidinedione, or a sodium–glucose cotransporter-2 inhibitor or a dipeptidyl peptidase-4 inhibitor may also be included.
- Utilize human insulin to manage blood glucose in adults with Type 1 diabetes and in adults with Type 2 diabetes for whom insulin is indicated.
- Contemplate long-acting insulin to manage blood glucose in adults with Type 1 or Type 2 diabetes who often have severe hypoglycemia with human insulin.
In comparison, 2013 WHO guidelines for low-resource settings recommended metformin for first-line treatment of Type 2 diabetes, sulfonylureas for second-line treatment, and human insulin for third-line treatment.
According to Roglic and Norris, “the guidelines are intended for settings with limited health system resources where the healthcare budget can be quickly exhausted by the widespread use of expensive brand-name medications.”
In such settings, the authors also state patients frequently have to pay out of pocket for treatment. The guidelines also apply to high-income countries where patients with limited resources need evidence-based care that takes into account costs and value.