2021 Clinical Practice Guidelines for Diabetes Mellitus of the Korean Diabetes Association

Abstract

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.

Long-term effectiveness and safety of quadruple combination therapy with empagliflozin versus dapagliflozin in patients with type 2 diabetes: 3-year prospective observational study

“…As T2D is a progressive complex disease, maintenance of glycemic goals for extended periods of time with monotherapy is often challenging in many patients. Current guidelines recommend that treatment intensification should not be delayed for patients who do not meet their treatment goals [2,3,15]. Injectable therapy with insulin or GLP-1RA can effectively improve glycemic control in patients who have failed with OADs, but there is a population of patients that are often reluctant to initiate injectable therapy for a variety of personal reasons [4,[23][24][25].…”

“…However, the decision on choosing an effective treatment regimen remains challenging. Depending upon the individual, the available drug treatments cannot provide consistent control of the circulating glucose levels, so there is little effect in slowing the onset and progression of cardiovascular and renal injuries [2,3]. Even though injectable forms of antidiabetic drugs, such as insulin or glucagon-like peptide-1 receptor agonist (GLP-1RA), are highly effective, but not all patients and even physicians are willing to initiate or maintain their use due to underlying psychological barriers [2,3,4].…”

“…Depending upon the individual, the available drug treatments cannot provide consistent control of the circulating glucose levels, so there is little effect in slowing the onset and progression of cardiovascular and renal injuries [2,3]. Even though injectable forms of antidiabetic drugs, such as insulin or glucagon-like peptide-1 receptor agonist (GLP-1RA), are highly effective, but not all patients and even physicians are willing to initiate or maintain their use due to underlying psychological barriers [2,3,4]. More recently, there are increasing reports that administration of a combination therapy of oral antidiabetic drugs (OADs) with distinct modes of action at an earlier stage of T2D development may have more benefit than a drug regimen that sequentially escalates dosing with one or more drugs [6,7].…”

“…Large scale clinical trials evaluating the use of SGLT2 inhibitors, including empagliflozin and dapagliflozin, for T2D exhibited considerable benefits to both cardiovascular and kidney function [12][13][14]. This led to the priority recommendation for these types of OAD to become part of any treatment regimen in patients with uncontrolled glycemia [2,3,12,13,15].Despite the growing acceptance over the past several years to therapeutically treat T2D using SGLT2 inhibitors, there is still a need to better understand the safety and effectiveness of these drugs in this patient population, especially as part of a larger combination therapy regimen.…”

Oral Semaglutide, the First Ingestible Glucagon-Like Peptide-1 Receptor Agonist: Could It Be a Magic Bullet for Type 2 Diabetes?

“…Over the recent decade, new antidiabetic drugs have been introduced, expanding T2D therapy choices while also increasing treatment complexity [ 1 , 2 ]. Along with the development of novel agents, recent guidelines stress the patient’s coexisting diseases and risk factors before glycemic control, recommending medications with cardiovascular and renal benefits over those with glycemic control [ 2 , 3 , 4 ].…”