Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Review article: Medical guidelines

Vol. 153 No. 4 (2023)

Swiss recommendations of the Society for Endocrinology and Diabetes (SGED/SSED) for the treatment of type 2 diabetes mellitus (2023)

  • Giacomo Gastaldi
  • Barbara Lucchini
  • Sebastien Thalmann
  • Stephanie Alder
  • Markus Laimer
  • Michael Brändle
  • Peter Wiesli
  • Roger Lehmann
  • Working group of the SGED/SSED
DOI
https://doi.org/10.57187/smw.2023.40060
Cite this as:
Swiss Med Wkly. 2023;153:40060
Published
01.04.2023

Summary

As a first step, the authors emphasise lifestyle changes (increased physical activity, stopping smoking), blood pressure control, and lowering cholesterol). The initial medical treatment should always be a combination treatment with metformin and a sodium-glucose transporter 2 (SGLT-2) inhibitor or a glucagon-like 1 peptide (GLP-1) receptor agonist. Metformin is given first and up-titrated, followed by SGLT-2 inhibitors or GLP-1 receptor agonists. In persons with type 2 diabetes, if the initial double combination is not sufficient, a triple combination (SGLT-2 inhibitor, GLP-1 receptor agonist, and metformin) is recommended. This triple combination has not been officially tested in cardiovascular outcome trials, but there is more and more real-world experience in Europe and in the USA that proves that the triple combination with metformin, SGLT-2 inhibitor, and GLP-1 receptor agonist is the best treatment to reduce 3-point MACE, total mortality, and heart failure as compared to other combinations. The treatment with sulfonylurea is no longer recommended because of its side effects and higher mortality compared to the modern treatment with SGLT-2 inhibitors and GLP-1 receptor agonists. If the triple combination is not sufficient to reduce the HbA1c to the desired target, insulin treatment is necessary. A quarter of all patients with type 2 diabetes (sometimes misdiagnosed) require insulin treatment. If insulin deficiency is the predominant factor at the outset of type 2 diabetes, the order of medications has to be reversed: insulin first and then cardio-renal protective medications (SGLT-2 inhibitors, GLP-1 receptor agonists).

References

  1. Green JB , Bethel MA , Armstrong PW , Buse JB , Engel SS , Garg J , et al.; TECOS Study Group . Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2015 Jul;373(3):232–42. https://doi.org/10.1056/NEJMoa1501352 DOI: https://doi.org/10.1056/NEJMoa1501352
  2. Rosenstock J , Kahn SE , Johansen OE , Zinman B , Espeland MA , Woerle HJ , et al.; CAROLINA Investigators . Effect of Linagliptin vs Glimepiride on Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes: The CAROLINA Randomized Clinical Trial. JAMA. 2019 Sep;322(12):1155–66. https://doi.org/10.1001/jama.2019.13772 DOI: https://doi.org/10.1001/jama.2019.13772
  3. Rosenstock J , Perkovic V , Johansen OE , Cooper ME , Kahn SE , Marx N , et al.; CARMELINA Investigators . Effect of Linagliptin vs Placebo on Major Cardiovascular Events in Adults With Type 2 Diabetes and High Cardiovascular and Renal Risk: The CARMELINA Randomized Clinical Trial. JAMA. 2019 Jan;321(1):69–79. https://doi.org/10.1001/jama.2018.18269 DOI: https://doi.org/10.1001/jama.2018.18269
  4. Scirica BM , Bhatt DL , Braunwald E , Steg PG , Davidson J , Hirshberg B , et al.; SAVOR-TIMI 53 Steering Committee and Investigators . Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013 Oct;369(14):1317–26. https://doi.org/10.1056/NEJMoa1307684 DOI: https://doi.org/10.1056/NEJMoa1307684
  5. Jhund PS , Kondo T , Butt JH , Docherty KF , Claggett BL , Desai AS , et al. Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER. Nat Med. 2022 Sep;28(9):1956–64. https://doi.org/10.1038/s41591-022-01971-4 DOI: https://doi.org/10.1038/s41591-022-01971-4
  6. Bellastella G , Maiorino MI , Longo M , Scappaticcio L , Chiodini P , Esposito K , et al. Glucagon-Like Peptide-1 Receptor Agonists and Prevention of Stroke Systematic Review of Cardiovascular Outcome Trials With Meta-Analysis. Stroke. 2020 Feb;51(2):666–9. https://doi.org/10.1161/STROKEAHA.119.027557 DOI: https://doi.org/10.1161/STROKEAHA.119.027557
  7. Husain M , Birkenfeld AL , Donsmark M , Dungan K , Eliaschewitz FG , Franco DR , et al.; PIONEER 6 Investigators . Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2019 Aug;381(9):841–51. https://doi.org/10.1056/NEJMoa1901118 DOI: https://doi.org/10.1056/NEJMoa1901118
  8. Mann JF , Ørsted DD , Brown-Frandsen K , Marso SP , Poulter NR , Rasmussen S , et al.; LEADER Steering Committee and Investigators . Liraglutide and Renal Outcomes in Type 2 Diabetes. N Engl J Med. 2017 Aug;377(9):839–48. https://doi.org/10.1056/NEJMoa1616011 DOI: https://doi.org/10.1056/NEJMoa1616011
  9. Marso SP , Bain SC , Consoli A , Eliaschewitz FG , Jódar E , Leiter LA , et al.; SUSTAIN-6 Investigators . Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016 Nov;375(19):1834–44. https://doi.org/10.1056/NEJMoa1607141 DOI: https://doi.org/10.1056/NEJMoa1607141
  10. Marso SP , Daniels GH , Brown-Frandsen K , Kristensen P , Mann JF , Nauck MA , et al.; LEADER Steering Committee; LEADER Trial Investigators . Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016 Jul;375(4):311–22. https://doi.org/10.1056/NEJMoa1603827 DOI: https://doi.org/10.1056/NEJMoa1603827
  11. Neal B , Perkovic V , Mahaffey KW , de Zeeuw D , Fulcher G , Erondu N , et al.; CANVAS Program Collaborative Group . Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017 Aug;377(7):644–57. https://doi.org/10.1056/NEJMoa1611925 DOI: https://doi.org/10.1056/NEJMoa1611925
  12. Cannon CP , Pratley R , Dagogo-Jack S , Mancuso J , Huyck S , Masiukiewicz U , et al.; VERTIS CV Investigators . Cardiovascular Outcomes with Ertugliflozin in Type 2 Diabetes. N Engl J Med. 2020 Oct;383(15):1425–35. https://doi.org/10.1056/NEJMoa2004967 DOI: https://doi.org/10.1056/NEJMoa2004967
  13. Gerstein HC , Colhoun HM , Dagenais GR , Diaz R , Lakshmanan M , Pais P , et al.; REWIND Investigators . Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019 Jul;394(10193):121–30. https://doi.org/10.1016/S0140-6736(19)31149-3 DOI: https://doi.org/10.1016/S0140-6736(19)31149-3
  14. Gerstein HC , Sattar N , Rosenstock J , Ramasundarahettige C , Pratley R , Lopes RD , et al.; AMPLITUDE-O Trial Investigators . Cardiovascular and Renal Outcomes with Efpeglenatide in Type 2 Diabetes. N Engl J Med. 2021 Sep;385(10):896–907. https://doi.org/10.1056/NEJMoa2108269 DOI: https://doi.org/10.1056/NEJMoa2108269
  15. Zinman B , Wanner C , Lachin JM , Fitchett D , Bluhmki E , Hantel S , et al.; EMPA-REG OUTCOME Investigators . Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015 Nov;373(22):2117–28. https://doi.org/10.1056/NEJMoa1504720 DOI: https://doi.org/10.1056/NEJMoa1504720
  16. Davies MJ , Aroda VR , Collins BS , Gabbay RA , Green J , Maruthur NM , et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022 Nov;45(11):2753–86. https://doi.org/10.2337/dci22-0034 DOI: https://doi.org/10.2337/dci22-0034
  17. Visseren FL , Mach F , Smulders YM , Carballo D , Koskinas KC , Bäck M , et al.; ESC National Cardiac Societies; ESC Scientific Document Group . 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021 Sep;42(34):3227–337. https://doi.org/10.1093/eurheartj/ehab484 DOI: https://doi.org/10.1093/eurheartj/ehab484
  18. Jensen MH , Kjolby M , Hejlesen O , Jakobsen PE , Vestergaard P . Risk of Major Adverse Cardiovascular Events, Severe Hypoglycemia, and All-Cause Mortality for Widely Used Antihyperglycemic Dual and Triple Therapies for Type 2 Diabetes Management: A Cohort Study of All Danish Users. Diabetes Care. 2020 Jun;43(6):1209–18. https://doi.org/10.2337/dc19-2535 DOI: https://doi.org/10.2337/dc19-2535
  19. Dave CV , Kim SC , Goldfine AB , Glynn RJ , Tong A , Patorno E . Risk of Cardiovascular Outcomes in Patients With Type 2 Diabetes After Addition of SGLT2 Inhibitors Versus Sulfonylureas to Baseline GLP-1RA Therapy. Circulation. 2021 Feb;143(8):770–9. https://doi.org/10.1161/CIRCULATIONAHA.120.047965 DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.047965
  20. Lean ME , Leslie WS , Barnes AC , Brosnahan N , Thom G , McCombie L , et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018 Feb;391(10120):541–51. https://doi.org/10.1016/S0140-6736(17)33102-1 DOI: https://doi.org/10.1016/S0140-6736(17)33102-1
  21. Dansinger ML , Gleason JA , Griffith JL , Selker HP , Schaefer EJ . Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005 Jan;293(1):43–53. https://doi.org/10.1001/jama.293.1.43 DOI: https://doi.org/10.1001/jama.293.1.43
  22. Wilding JP , Batterham RL , Calanna S , Davies M , Van Gaal LF , Lingvay I , et al.; STEP 1 Study Group . Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar;384(11):989–1002. https://doi.org/10.1056/NEJMoa2032183 DOI: https://doi.org/10.1056/NEJMoa2032183
  23. Jastreboff AM , Aronne LJ , Ahmad NN , Wharton S , Connery L , Alves B , et al.; SURMOUNT-1 Investigators . Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul;387(3):205–16. https://doi.org/10.1056/NEJMoa2206038 DOI: https://doi.org/10.1056/NEJMoa2206038
  24. Mori Y , Duru OK , Tuttle KR , Fukuma S , Taura D , Harada N , et al. Sodium-Glucose Cotransporter 2 Inhibitors and New-onset Type 2 Diabetes in Adults with Prediabetes: systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2022 Dec;108(1):221–31. https://doi.org/10.1210/clinem/dgac591 DOI: https://doi.org/10.1210/clinem/dgac591
  25. Gæde P , Oellgaard J , Carstensen B , Rossing P , Lund-Andersen H , Parving HH , et al. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial. Diabetologia. 2016 Nov;59(11):2298–307. https://doi.org/10.1007/s00125-016-4065-6 DOI: https://doi.org/10.1007/s00125-016-4065-6
  26. Huber CA , Reich O , Früh M , Rosemann T . Effects of Integrated Care on Disease-Related Hospitalisation and Healthcare Costs in Patients with Diabetes, Cardiovascular Diseases and Respiratory Illnesses: A Propensity-Matched Cohort Study in Switzerland. Int J Integr Care. 2016 Apr;16(1):11. https://doi.org/10.5334/ijic.2455 DOI: https://doi.org/10.5334/ijic.2455
  27. Christ E , Czock A , Renström F , Ammeter T , Ebrahimi F , Zechmann S , et al. Evaluation of type 2 diabetes care management in nine primary care practices before and after implementation of the Criteria of Good Disease Management of Diabetes established by the Swiss Society of Endocrinology and Diabetology. Swiss Med Wkly. 2022 Jul;152(2930):w30197. https://doi.org/10.4414/SMW.2022.w30197 DOI: https://doi.org/10.4414/SMW.2022.w30197
  28. Heerspink HJ , Langkilde AM , Wheeler DC . Dapagliflozin in Patients with Chronic Kidney Disease. Reply [Reply]. N Engl J Med. 2021 Jan;384(4):389–90. DOI: https://doi.org/10.1056/NEJMc2032809
  29. Agarwal R , Kolkhof P , Bakris G , Bauersachs J , Haller H , Wada T , et al. Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J. 2021 Jan;42(2):152–61. https://doi.org/10.1093/eurheartj/ehaa736 DOI: https://doi.org/10.1093/eurheartj/ehaa736
  30. Pitt B , Filippatos G , Agarwal R , Anker SD , Bakris GL , Rossing P , et al.; FIGARO-DKD Investigators . Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 2021 Dec;385(24):2252–63. https://doi.org/10.1056/NEJMoa2110956 DOI: https://doi.org/10.1056/NEJMoa2110956
  31. Bakris GL , Agarwal R , Anker SD , Pitt B , Ruilope LM , Rossing P , et al.; FIDELIO-DKD Investigators . Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020 Dec;383(23):2219–29. https://doi.org/10.1056/NEJMoa2025845 DOI: https://doi.org/10.1056/NEJMoa2025845
  32. Boonman-de Winter LJ , Rutten FH , Cramer MJ , Landman MJ , Liem AH , Rutten GE , et al. High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes. Diabetologia. 2012 Aug;55(8):2154–62. https://doi.org/10.1007/s00125-012-2579-0 DOI: https://doi.org/10.1007/s00125-012-2579-0
  33. Pop-Busui R , Januzzi JL , Bruemmer D , Butalia S , Green JB , Horton WB , et al. Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association. Diabetes Care. 2022 Jul;45(7):1670–90. https://doi.org/10.2337/dci22-0014 DOI: https://doi.org/10.2337/dci22-0014
  34. McDonagh TA , Metra M , Adamo M , Gardner RS , Baumbach A , Böhm M , et al.; ESC Scientific Document Group . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep;42(36):3599–726. https://doi.org/10.1093/eurheartj/ehab368 DOI: https://doi.org/10.1093/eurheartj/ehab368
  35. Pandey A , Vaduganathan M , Patel KV , Ayers C , Ballantyne CM , Kosiborod MN , et al. Biomarker-Based Risk Prediction of Incident Heart Failure in Pre-Diabetes and Diabetes. JACC Heart Fail. 2021 Mar;9(3):215–23. https://doi.org/10.1016/j.jchf.2020.10.013 DOI: https://doi.org/10.1016/j.jchf.2020.10.013
  36. McMurray JJ , Solomon SD , Inzucchi SE , Køber L , Kosiborod MN , Martinez FA , et al.; DAPA-HF Trial Committees and Investigators . Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov;381(21):1995–2008. https://doi.org/10.1056/NEJMoa1911303 DOI: https://doi.org/10.1002/ejhf.1548
  37. Petrie MC , Verma S , Docherty KF , Inzucchi SE , Anand I , Belohlávek J , et al. Effect of Dapagliflozin on Worsening Heart Failure and Cardiovascular Death in Patients With Heart Failure With and Without Diabetes. JAMA. 2020 Apr;323(14):1353–68. https://doi.org/10.1001/jama.2020.1906 DOI: https://doi.org/10.1001/jama.2020.1906
  38. Solomon SD , McMurray JJ , Claggett B , de Boer RA , DeMets D , Hernandez AF , et al.; DELIVER Trial Committees and Investigators . Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 2022 Sep;387(12):1089–98. https://doi.org/10.1056/NEJMoa2206286 DOI: https://doi.org/10.1056/NEJMoa2206286
  39. Anker SD , Butler J , Filippatos G , Ferreira JP , Bocchi E , Böhm M , et al.; EMPEROR-Preserved Trial Investigators . Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021 Oct;385(16):1451–61. https://doi.org/10.1056/NEJMoa2107038 DOI: https://doi.org/10.1056/NEJMoa2107038
  40. Eurich DT , Weir DL , Majumdar SR , Tsuyuki RT , Johnson JA , Tjosvold L , et al. Comparative safety and effectiveness of metformin in patients with diabetes mellitus and heart failure: systematic review of observational studies involving 34,000 patients. Circ Heart Fail. 2013 May;6(3):395–402. https://doi.org/10.1161/CIRCHEARTFAILURE.112.000162 DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.112.000162
  41. Sattar N , Lee MM , Kristensen SL , Branch KR , Del Prato S , Khurmi NS , et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. Lancet Diabetes Endocrinol. 2021 Oct;9(10):653–62. https://doi.org/10.1016/S2213-8587(21)00203-5 DOI: https://doi.org/10.1016/S2213-8587(21)00203-5
  42. Richardson TL Jr , Hackstadt AJ , Hung AM , Greevy RA , Grijalva CG , Griffin MR , et al. Hospitalization for Heart Failure Among Patients With Diabetes Mellitus and Reduced Kidney Function Treated With Metformin Versus Sulfonylureas: A Retrospective Cohort Study. J Am Heart Assoc. 2021 Apr;10(8):e019211. https://doi.org/10.1161/JAHA.120.019211 DOI: https://doi.org/10.1161/JAHA.120.019211
  43. Nissen SE , Wolski K . Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007 Jun;356(24):2457–71. https://doi.org/10.1056/NEJMoa072761 DOI: https://doi.org/10.1056/NEJMoa072761
  44. Stumvoll M , Goldstein BJ , van Haeften TW . Type 2 diabetes: principles of pathogenesis and therapy. Lancet. 2005 Apr;365(9467):1333–46. https://doi.org/10.1016/S0140-6736(05)61032-X DOI: https://doi.org/10.1016/S0140-6736(05)61032-X
  45. Rubino D , Abrahamsson N , Davies M , Hesse D , Greenway FL , Jensen C , et al.; STEP 4 Investigators . Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021 Apr;325(14):1414–25. https://doi.org/10.1001/jama.2021.3224 DOI: https://doi.org/10.1001/jama.2021.3224
  46. Ahlqvist E , Prasad RB , Groop L . Subtypes of Type 2 Diabetes Determined From Clinical Parameters. Diabetes. 2020 Oct;69(10):2086–93. https://doi.org/10.2337/dbi20-0001 DOI: https://doi.org/10.2337/dbi20-0001
  47. Holt RI , DeVries JH , Hess-Fischl A , Hirsch IB , Kirkman MS , Klupa T , et al. The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2021 Dec;64(12):2609–52. https://doi.org/10.1007/s00125-021-05568-3 DOI: https://doi.org/10.1007/s00125-021-05568-3
  48. Davis AK , DuBose SN , Haller MJ , Miller KM , DiMeglio LA , Bethin KE , et al.; T1D Exchange Clinic Network . Prevalence of detectable C-Peptide according to age at diagnosis and duration of type 1 diabetes. Diabetes Care. 2015 Mar;38(3):476–81. https://doi.org/10.2337/dc14-1952 DOI: https://doi.org/10.2337/dc14-1952
  49. Philis-Tsimikas A , Astamirova K , Gupta Y , Haggag A , Roula D , Bak BA , et al. Similar glycaemic control with less nocturnal hypoglycaemia in a 38-week trial comparing the IDegAsp co-formulation with insulin glargine U100 and insulin aspart in basal insulin-treated subjects with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2019 Jan;147:157–65. https://doi.org/10.1016/j.diabres.2018.10.024 DOI: https://doi.org/10.1016/j.diabres.2018.10.024
  50. American Diabetes Association Professional Practice Committee . 13. Older Adults: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan;45 Suppl 1:S195–207. https://doi.org/10.2337/dc22-S013 DOI: https://doi.org/10.2337/dc22-S013
  51. Sinclair AJ , Rodriguez-Mañas L . Diabetes and Frailty: Two Converging Conditions? Can J Diabetes. 2016 Feb;40(1):77–83. https://doi.org/10.1016/j.jcjd.2015.09.004 DOI: https://doi.org/10.1016/j.jcjd.2015.09.004
  52. Cowie CC , Rust KF , Ford ES , Eberhardt MS , Byrd-Holt DD , Li C , et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006. Diabetes Care. 2009 Feb;32(2):287–94. https://doi.org/10.2337/dc08-1296 DOI: https://doi.org/10.2337/dc08-1296
  53. Longo M , Bellastella G , Maiorino MI , Meier JJ , Esposito K , Giugliano D . Diabetes and Aging: From Treatment Goals to Pharmacologic Therapy. Front Endocrinol (Lausanne). 2019 Feb;10:45. https://doi.org/10.3389/fendo.2019.00045 DOI: https://doi.org/10.3389/fendo.2019.00045
  54. Choi JG , Winn AN , Skandari MR , Franco MI , Staab EM , Alexander J , et al. First-Line Therapy for Type 2 Diabetes With Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists : A Cost-Effectiveness Study. Ann Intern Med. 2022 Oct;175(10):1392–400. https://doi.org/10.7326/M21-2941 DOI: https://doi.org/10.7326/M21-2941
  55. Zozaya N , Capel M , Simon S , Soto-Gonzales A . A systematic review of economic evaluations in non-insulin antidiabetic treatments for patients with type 2 diabetes mellitus. Glob Reg Health Technol Assess. 2019;2019:1–26. https://doi.org/10.1177/2284240319876574 DOI: https://doi.org/10.1016/j.jval.2018.09.788
  56. Willis M , Nilsson A , Kellerborg K , Ball P , Roe R , Traina S , et al. Cost-Effectiveness of Canagliflozin Added to Standard of Care for Treating Diabetic Kidney Disease (DKD) in Patients with Type 2 Diabetes Mellitus (T2DM) in England: Estimates Using the CREDEM-DKD Model. Diabetes Ther. 2021 Jan;12(1):313–28. https://doi.org/10.1007/s13300-020-00968-x DOI: https://doi.org/10.1007/s13300-020-00968-x
  57. McEwan P , Darlington O , McMurray JJ , Jhund PS , Docherty KF , Böhm M , et al. Cost-effectiveness of dapagliflozin as a treatment for heart failure with reduced ejection fraction: a multinational health-economic analysis of DAPA-HF. Eur J Heart Fail. 2020 Nov;22(11):2147–56. https://doi.org/10.1002/ejhf.1978 DOI: https://doi.org/10.1002/ejhf.1978
  58. Hunt B , Malkin SJ , Moes RG , Huisman EL , Vandebrouck T , Wolffenbuttel BH . Once-weekly semaglutide for patients with type 2 diabetes: a cost-effectiveness analysis in the Netherlands. BMJ Open Diabetes Res Care. 2019 Oct;7(1):e000705. https://doi.org/10.1136/bmjdrc-2019-000705 DOI: https://doi.org/10.1136/bmjdrc-2019-000705
  59. Guzauskas GF , Rind DM , Fazioli K , Chapman RH , Pearson SD , Hansen RN . Cost-effectiveness of oral semaglutide added to current antihyperglycemic treatment for type 2 diabetes. J Manag Care Spec Pharm. 2021 Apr;27(4):455–68. https://doi.org/10.18553/jmcp.2021.27.4.455 DOI: https://doi.org/10.18553/jmcp.2021.27.4.455
  60. Shah D , Risebrough NA , Perdrizet J , Iyer NN , Gamble C , Dang-Tan T . Cost-effectiveness and budget impact of liraglutide in type 2 diabetes patients with elevated cardiovascular risk: a US-managed care perspective. Clinicoecon Outcomes Res. 2018 Nov;10:791–803. https://doi.org/10.2147/CEOR.S180067 DOI: https://doi.org/10.2147/CEOR.S180067
  61. Aeberli I , Molinari L , Spinas G , Lehmann R , l’Allemand D , Zimmermann MB . Dietary intakes of fat and antioxidant vitamins are predictors of subclinical inflammation in overweight Swiss children. Am J Clin Nutr. 2006 Oct;84(4):748–55. https://doi.org/10.1093/ajcn/84.4.748 DOI: https://doi.org/10.1093/ajcn/84.4.748
  62. Schneider L , Lehmann R . Swiss Diabetes Guide: Entscheidungshilfe für eine personalisierte Therapie beim Typ 2 Diabetes mellitus (SGED 2020). Swiss Medical Forum. 2021;21:251–6. DOI: https://doi.org/10.4414/fms.2021.08780
  63. van Berlo-van de Laar IR , Vermeij CG , Doorenbos CJ . Metformin associated lactic acidosis: incidence and clinical correlation with metformin serum concentration measurements. J Clin Pharm Ther. 2011 Jun;36(3):376–82. https://doi.org/10.1111/j.1365-2710.2010.01192.x DOI: https://doi.org/10.1111/j.1365-2710.2010.01192.x
  64. Liu J , Li L , Li S , Wang Y , Qin X , Deng K , et al. Sodium-glucose co-transporter-2 inhibitors and the risk of diabetic ketoacidosis in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2020 Sep;22(9):1619–27. https://doi.org/10.1111/dom.14075 DOI: https://doi.org/10.1111/dom.14075
  65. Colacci M , Fralick M . Response: Sodium-Glucose Cotransporter-2 Inhibitors and Risk of Diabetic Ketoacidosis Among Adults With Type 2 Diabetes: A Systematic Review and Meta-Analysis. Can J Diabetes. 2022 Mar;46(2):110. https://doi.org/10.1016/j.jcjd.2021.10.003 DOI: https://doi.org/10.1016/j.jcjd.2021.10.003