Cost a key consideration of WHO guidelines for diabetes treatment intensification

1. WHO guidelines recommend selecting sulfonylureas as the single best second-line agent for Type 2 Diabetes Mellitus (T2DM) patients.

2. Authors of a commentary on the WHO guidelines highlighted the prioritization of cost in the clinical decision-making.

Evidence Rating Level: 2 (Good)

Study Rundown: T2DM remains an increasing health concern for patients, resulting in significant morbidity in many of those affected. The World Health Organization (WHO) recently issued guidelines regarding medication selection for treatment intensification in patients with T2DM. It also addressed insulin use in patients with Type 1 or 2 Diabetes. The WHO guidelines consisted of five overall recommendations. Of note, sulfonylureas are recommended as the best second-line agent for T2DM. With respect to limitations, the authors of an accompanying commentary compared the American College of Physicians (ACP) guidelines on diabetes treatment with WHO guidelines. They reflected that the WHO guidelines prioritized cost more heavily in the recommendations of T2DM medications, due to the necessity for WHO guidelines to also apply to low-resource settings.

Click to read the study in Annals of Internal Medicine

Click to read an accompanying Editorial

Relevant Reading: The interdisciplinary team in type 2 diabetes management: Challenges and best practice solutions from real-world scenarios

In-Depth [clinical guidelines]: WHO developed diabetes medication guidelines targeted towards an audience of clinicians, policymakers, national diabetes program managers, and medicine procurement officers. The recommendations were synthesized through a 12-member development group, followed by a peer review from 6 external reviewers. All recommendations were based on high-quality systematic reviews and were rated with respect to recommendation strength and evidence quality. Guidelines included recommending introducing human insulin treatment to patients with T2DM that are not achieving glycemic control with metformin and/or a sulfonylurea. Further, it was suggested to consider long-acting insulin analogues in patients who have frequent severe hypoglycemia events.

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