Changes to PBS reimbursements and new evidence have triggered an update in the Australian Diabetes Society’s position statement on blood glucose management in type 2 diabetes.
According to ADS president Professor Sophia Zoungas, new therapies have made the clinical pathway more complicated since the 2014 version but also opened up opportunities to individualise therapy.
“A number of important randomised controlled trials have provided new evidence to inform our treatment algorithm. These included evidence that the SGLT-2 inhibitor empagliflozin reduces cardiovascular deaths and hospitalisations for heart failure.”
“GLP-1 receptor agonist liraglutide has also showed benefit in terms of cardiovascular outcomes,” she said.
Professor Zoungas, chair in diabetes, vascular health and ageing at Monash University, told the limbic that there was still an evidence gap in terms of comparative head to head trials.
“We now have lots of placebo controlled trials but we need the comparative effectiveness research to show us which drug is better – whether to choose drug X over drug Y or when to add in the next drug.”
The position statement incorporates PBS changes particularly around combinations of treatments including DDP-4 inhibitors for dual and triple therapy and GLP-1RA for triple therapy.
Also included are tables of evidence, medication combinations potentially attracting PBS subsidy and the costs of glucose-lowering medications with and without PBS subsidy.
The position statement, treatment algorithm and case studies are available on a new website http://t2d.diabetessociety.com.au targeted to health professionals but also accessible by consumers.
The ADS has partnered with the RACGP and NPS to help ensure treatment information provided to patients via doctors, pharmacists and diabetes educators is clear and consistent.
Professor Zoungas said the website should be a useful resource to all health professionals including specialists, their trainees, practice staff and multidisciplinary teams.