{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nznfe2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nznfe2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;12\\\/10\\\/35\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;12\\\/10\\\/35\u0022}],\u0022ac\u0022:{\u0022spmdc;12\\\/10\\\/35\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;12\\\/10\\\/35\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EGlycemic management in type 2 diabetes mellitus (T2DM) has become increasingly complex and, to some extent, controversial. A widening array of pharmacological agents [Nyenwe EA et al. \u003Cem\u003EMetabolism\u003C\/em\u003E 2011; Blonde L. \u003Cem\u003EAm J Med\u003C\/em\u003E 2010; Bergenstal RM et al. \u003Cem\u003EAm J Med\u003C\/em\u003E 2010] has raised concerns about their potential adverse effects, as well as new uncertainties about the effects of intensive glycemic control on macrovascular complications [Yudkin JS et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011]. This article reviews key points from the new Position Statement from the American Diabetes Association and the European Association for the Study of Diabetes [Inzucchi SE et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012; Inzucchi SE et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHyperglycemia\/Hypoglycemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENursing\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Endocrinology Guidelines\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EOverview\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003EGlycemic management in type 2 diabetes mellitus (T2DM) has become increasingly complex and, to some extent, controversial. A widening array of pharmacological agents [Nyenwe EA et al. \u003Cem\u003EMetabolism\u003C\/em\u003E 2011; Blonde L. \u003Cem\u003EAm J Med\u003C\/em\u003E 2010; Bergenstal RM et al. \u003Cem\u003EAm J Med\u003C\/em\u003E 2010] has raised concerns about their potential adverse effects, as well as new uncertainties about the effects of intensive glycemic control on macrovascular complications [Yudkin JS et al. \u003Cem\u003ELancet 2011\u003C\/em\u003E]. Many clinicians are, therefore, perplexed as to the optimal treatment strategies for their patients [Inzucchi SE et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012; Inzucchi SE et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ESilvio E. Inzucchi, MD, Yale University School of Medicine, New Haven, Connecticut, USA, reviewed key points from the new Position Statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) [Inzucchi SE et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012; Inzucchi SE et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe statement covers the growing variety and number of antihyperglycemic agents, new data on the benefits versus risks of tight glycemic control, increasing concerns about drug safety, and growing discourse about personalized medicine and patient-centered care. Dr. Inzucchi pointed out that prior guidelines were consensus documents that did not undergo formal Association review to become official position statements.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMain Pathological Defects in T2DM\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAny rise in glycemia is the net result of glucose influx exceeding glucose outflow from the plasma compartment [Inzucchi SE et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012; Inzucchi SE et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012]. In the fasting state, hyperglycemia is directly related to increased hepatic glucose production. In the postprandial state, further glucose excursions result from the combination of insufficient suppression of this glucose output and defective insulin stimulation of glucose disposal in target tissues, mainly skeletal muscle.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAbnormal islet cell function that progresses over time is a key and requisite feature of T2DM and the main quantitative determinant of hyperglycemia [Ferrannini E et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2005] (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). However, islet dysfunction is not necessarily irreversible. It responds to increased insulin action that relieves \u03b2-cell secretory burden and any intervention that improves glycemia, from energy restriction to bariatric surgery [Ferrannini E. \u003Cem\u003ECell Metab\u003C\/em\u003E 2010]. More recently, abnormalities in the incretin system have also been identified [Nauck MA. \u003Cem\u003EAm J Med\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/35\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Main Pathophysiological Defects in T2DM.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1671442201\u0022 data-figure-caption=\u0022Main Pathophysiological Defects in T2DM.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/35\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/35\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/35\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12756\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EMain Pathophysiological Defects in T2DM.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from SE Inzucchi, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EAntihyperglycemic agents are directed at one or more of the pathophysiological defects of T2DM, or they modify physiological processes related to appetite or to nutrient absorption or excretion. Ultimately, T2DM is a disease that is heterogeneous in both its pathogenesis and clinical manifestation. This point must be considered when determining the optimal therapeutic strategy for individual patients [Inzucchi SE et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012; Inzucchi SE et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPatient-Centered Approach\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EAccording to Dr. Inzucchi, patient-centered care is defined as an approach to providing treatment that is respectful of and responsive to an individual patient\u0027s preferences, needs, and values, and it ensures that a patient\u0027s values guide all clinical decisions [Committee on Quality of Health Care in America: Institute of Medicine. \u003Cem\u003EThe National Academies Pre\u003C\/em\u003Ess 2001]. He noted that this should be the organizing principle underlying health care for individuals with any chronic disease, but it is especially pertinent in T2DM, with the uncertainties of choice as well as the sequence of therapy [Inzucchi et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012; Inzucchi SE et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EIn a shared decision-making approach, the clinician and the patient act as partners, mutually exchanging information and deliberating on options to reach a consensus on the therapeutic course of action [Tsapas A, Matthews DR. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2008]. Ultimately, the patient makes the final decisions regarding lifestyle choices and, to some degree, the pharmaceutical interventions used [Inzucchi SE et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012; Inzucchi SE et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EA patient\u0027s involvement in medical decision-making constitutes one of the core principles of evidence-based medicine, which mandates the synthesis of best available evidence from the literature with the clinician\u0027s expertise and the patient\u0027s inclination [Guyatt GH et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2000]. The implementation of the plan occurs in the context of a patient\u0027s real life and his consumption of public and private resources [Inzucchi SE et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012; Inzucchi SE et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EFor many people with complex, chronic comorbidities, the burden of treatment reduces their capacity to collaborate in their care. Therefore, clinicians must establish the weight of burden, encourage coordination in clinical practice, acknowledge comorbidity in clinical evidence, and prioritize from the patient\u0027s perspective [May C et al. \u003Cem\u003EBMJ\u003C\/em\u003E 2009].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPosition Statement\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EThe document refers to glycemic control pursued within a multifactorial risk-reduction framework. Such a framework is necessary because patients with T2DM are at increased risk of cardiovascular (CV) morbidity and mortality. Aggressive management of CV risk factors (blood pressure and lipid therapy, antiplatelet treatment, and smoking cessation) is likely to have even greater benefits among these patients [Inzucchi SE et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012; Inzucchi SE et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EThe key points of the ADA\/EASD Position Statement: Management of Hyperglycemia in Type 2 Diabetes are: 1) glycemic target blood-glucose lowering therapies must be individualized; 2) diet, exercise, and education are the foundation of any T2DM therapy program; 3) unless contraindicated, metformin is the optimal first-line drug; 4) after metformin, data are limited; combination therapy with one or two other oral\/injectable agents that minimize side effects is reasonable; 5) ultimately, many patients will require insulin therapy alone or in combination with other agents to maintain blood glucose control; 6) all treatment decisions should be made in conjunction with the patient (focus on preferences, needs, and values); and 7) comprehensive CV risk reduction is a major focus of therapy [Inzucchi SE et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012; Inzucchi SE et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003ECompared with the 2008 ADA\/EASD Treatment Algorithm, the 2012 statement is not as prescriptive\/algorithmic. It calibrates treatment targets to patients\u0027 needs and acknowledges the role of lifestyle change prior to metformin in selected patients. It individualizes treatment options and harmonizes 5 dual-therapy options after metformin. It recognizes the role of initial combination therapy (HbA1C \u0026gt;9%), and endorses triple therapy, when required. It also includes insulin options beyond basal and basal-bolus (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/35\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The ADA\/EASD Position Statement on Management of Hyperglycemia in T2DM.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1671442201\u0022 data-figure-caption=\u0022The ADA\/EASD Position Statement on Management of Hyperglycemia in T2DM.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/35\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/35\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/10\/35\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12757\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EThe ADA\/EASD Position Statement on Management of Hyperglycemia in T2DM.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from SE Inzucchi, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EThe position statement clearly argues for less stringent HbA1C goals in patients who are predisposed to hyperglycemia and have limited life expectancy, advanced complications, extensive comorbidities, or a glycemic target that is difficult to control despite intensive education, counseling, and effective doses of glucose-lowering agents.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EThe statement was developed over a period of approximately 2 years by an international writing group, chaired by Dr. Inzucchi and Professor David Matthews from Oxford University and underwent dozens of revisions with additional input from 25 experts around the world. It highlights a proposed patient-centered approach that provides not only the most comprehensive management strategy to date, but also the most vetted and thoroughly reviewed statement ever published [Cefalu CT. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EIt is an expansive approach that suggests recommendations considered within the context of the needs, preferences, and tolerances of each patient. At the same time, the recommendations clearly state that the informed judgment and expertise of experienced clinicians will always be necessary [Cefalu CT. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EThis new ADA\/EASD Position Statement will generate a wide range of opinions and emotions. However, no one will disagree with the fact that the initiative was conducted with due diligence deserving of a document that will likely have major impact for millions of patients throughout the world [Cefalu CT. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/10\/35.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznfe2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznfe2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}