In a recent issue of Diabetes Care, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published an updated position statement on the treatment of type 2 diabetes. Diabetes) published an updated position statement on the treatment of type 2 diabetes that emphasizes patient-centered care. Key recommendations of the new guidelines: . Individualized glycemic goals and hypoglycemic regimens must be developed based on patient-specific characteristics; . The mainstay of all type 2 diabetes treatment regimens remains diet, exercise and patient education; . In the absence of contraindications, metformin is the first-line glucose-lowering therapy of choice; . Limited data are available regarding the use of glucose-lowering agents other than metformin. It is reasonable to add one or two additional oral or injectable drugs to metformin for combination therapy to minimize side effects; . To control blood glucose, many patients will eventually need to be treated with insulin monotherapy or in combination with other hypoglycemic agents; . Patients should be involved in all treatment decisions as much as possible, and decisions should be made with a focus on their preferences, needs and interests; . One of the primary goals of glucose lowering should be an overall reduction in cardiovascular risk. Silvio E. Inzucchi, MD, PhD, director of the Yale Diabetes Center, who led the team that wrote the statement, noted that for patients with type 2 diabetes, emphasis should be placed on the management of other cardiovascular risk factors, such as antihypertensive and lipid-regulating therapy, antiplatelet therapy, and smoking cessation, in addition to glycemic control. According to Dr. Inzucchi, patient-centered therapy is an approach that respects and responds to the patient’s preferences, needs and values, and this approach is particularly applicable to patients with type 2 diabetes, where the decision of which lifestyle to adopt ultimately remains the patient’s own. In addition, involving patients in treatment decisions can help improve their adherence to treatment. Other recommendations of the new guidelines include: . Blood glucose control – The goal for hemoglobin A1c control remains the same as before at less than 7 percent. However, goals may be adjusted appropriately based on individual patient considerations, including: patient attitudes and expected treatment intensity, risk associated with hypoglycemia, other adverse events, disease duration, life expectancy, significant comorbidities, vascular complications, resources, and support systems. . Lifestyle interventions – Lifestyle interventions aimed at increasing activity and optimizing food intake are the foundation of any type 2 diabetes treatment program. Standardized one-on-one or group-based general diabetes education is recommended for all patients. . Drug selection – As with previous guidelines, this statement also considers metformin to be the best first-line drug, unless contraindications exist. It is also reasonable to add one to two oral or injectable medications, although side effects need to be minimized. To maintain glycemic control, many patients need to receive insulin therapy alone or add other medications to insulin therapy. The statement recommends considering the addition of other major classes of glucose-lowering agents (sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor antagonists, and insulin) to metformin, as well as transitioning to insulin alone and various insulin-based regimens. . Patient considerations – Patient factors to consider include age, weight, gender/race/genetic differences, comorbidities, and hypoglycemia. Recent studies have found that hypoglycemia is much more harmful than previously thought, and therefore hypoglycemia in patients with type 2 diabetes should be more closely monitored. The statement concludes with a call for higher quality comparative studies of the efficacy of hypoglycemic agents and an increased focus on quality of life issues, complication avoidance, and glycemic control. In addition, clinical data on pharmacogenomics are needed to clarify how phenotypic and patient/disease-specific characteristics influence drug selection. Because head-to-head comparisons of all drug combinations require very large sample sizes and are less feasible, treatment relies on the empirical judgment of the clinician.