Overview

The new guidelines provide public health guidance on pharmacological agents for managing hyperglycaemia in type 1 and type 2 diabetes for use in primary health-care in low-resource settings. These guidelines update the recommendations for managing hyperglycaemia in the WHO Package of Essential NCD Interventions (WHO PEN) for primary care in low-resources settings, reviewing several newer oral agents as second- and third-line treatment: dipeptidyl peptidase-4 inhibitors, sodium-glucose co-transporter 2 inhibitors and thiazolidinediones. The guidelines also present recommendations on the selection of type of insulin (analogue versus human insulin) for adults with type 1 and type 2 diabetes.

Contents

• Abbreviations
• Glossary
• Executive summary
• 1. Introduction
  • 1.1. Scope and aim of guidelines
  • 1.2. Target audience
• 2. Methods for developing the guidelines
  • 2.1. Guideline contributors
  • 2.2. Outcome rating
  • 2.3. Reviews of evidence
  • 2.4. Quality of evidence and strength of recommendations
  • 2.5. Deciding upon recommendations
  • 2.6. Funding
• 3. Recommendations
  • 3.1. Hypoglycaemic agents for second-line treatment in type 2 diabetes
  • 3.2. Hypoglycaemic agents for third-line treatment in type 2 diabetes
  • 3.3. Insulin
• 4. Research gaps
  • 4.1. Oral hypoglycaemic agents
  • 4.2. Insulin
• 5. Publication, implementation and evaluation
  • 5.1. Publication
  • 5.2. Implementation and dissemination
  • 5.3. Evaluation
  • 5.4. Future updating of the guideline
• References
• Appendices
  • Appendix 1. Acknowledgements
  • Appendix 2. Managing declarations of interest and conflicts of interest
  • Appendix 3. PICO questions and ranked outcomes
  • Appendix 4. Methods for identification of recent high-quality systematic reviews
  • Appendix 5. Hypoglycaemic agents for second-line treatment in type 2 diabetes
  • Appendix 6. Price of Defined Daily Dose* of blood glucose-lowering medicines, compared to sulfonylurea
  • Appendix 7. Cost-effectiveness of medicines to treat Type 1 and Type 2 diabetes: a narrative review of the published literature
  • Appendix 8. Reviews of patient treatment preferences
  • Appendix 9. Hypoglycaemic agents for third-line treatment in type 2 diabetes
  • Appendix 10. Long-acting insulin analogues – summary of findings tables for critical outcomes
  • Appendix 11. Short-acting insulin analogues – summary of findings tables for critical outcomes

Suggested citation:

Guidelines on second- and third-line medicines and type of insulin for the control of blood glucose levels in non-pregnant adults with diabetes mellitus. Geneva: World Health Organization; 2018. Licence: CC BY-NCSA 3.0 IGO.

General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use.