Abstract
Important advances in 2021/2022 in the diagnosis and treatment of type 2 diabetes are discussed in this article. A new national guideline for pharmacotherapy of type 2 diabetes was recently published in Germany. In patients with pre-existing cardiovascular disease, drug treatment of type 2 diabetes should be started with a combination of metformin and a sodium glucose linked transporter 2 (SGLT-2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist with proven benefit in cardiovascular safety trials, respectively. Differential effects of antidiabetic compounds were analyzed in several large cohorts that included a high percentage of patients of lower cardiovascular risk. SGLT‑2 inhibitors and GLP‑1 receptor agonists appeared to be beneficial compared to sulfonylurea or dipeptidylpeptidase 4 (DPP-4) inhibitors. Current guidelines encourage physicians to de-escalate insulin therapy, especially in the elderly, when possible. Due to a focus on therapeutic safety and stable metabolism, continuous glucose monitoring is of increasing relevance also for patients with type 2 diabetes.
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