Paradigm Changes in Diabetes Management Guidelines: American Diabetes Association 2018.
Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. pjhdoc@chol.com
The management of type 2 diabetes mellitus should comprise healthy lifestyle modifications along with tailored pharmacologic treatment. Traditionally, the American Diabetes Association (ADA)'s Diabetes Management Guidelines have not prioritized specific anti-diabetic drugs over others with regard to cardiovascular disease (CVD) and mortality prevention. Recently, two novel anti-diabetic medications proved to be significantly protective against future CVD and mortality, regardless of the glycemic levels achieved in type 2 diabetic patients with pre-existing CVD. The 2018 ADA Guidelines recommend SGLT2 inhibitor and/or GLP-1 receptor agonist be used for type 2 diabetes patients with atherosclerotic CVD after metformin monotherapy failure. Considering the value of CVD protection in the management of diabetes mellitus, this minor guideline adjustment could have far-reaching implications.	
Key Words: Agonist, Cardiovascular diseases, Diabetes mellitus, Glucagon-like peptide-1 receptor, Inhibitor, Mortality, Sodium-glucose transporter 2	
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