The American Diabetes Association has released an update to its standards on the pharmacologic treatment of adults with type 2 diabetes.

On the basis of new evidence, early combination therapy is now recommended when glycemic control is not achieved within three months and in patients with cardiovascular disease, or chronic kidney disease and type 2 diabetes.

The ADA also advised that:

  • Lifestyle changes and metformin still are recommended as first-line treatments.
  • Insulin therapy should be discussed with patients as a way to escalate therapy rather than as a failure on the patient’s part.

The recommendations address oral and non insulin injectable therapies, insulin treatment, and combination injectable therapies. Results of recent large trials with cardiovascular and renal outcomes are emphasized.

A synopsis was published Tuesday in the Annals of Internal Medicine.