by Asim
(Riyadh)
QUESTION: I have had type 2 diabetes for eight years and use metformin and insulin. I keep hearing about new ADA and EASD guidelines, but I do not understand what they mean for me. Should I change medicines, use a glucose sensor, or do something different to lose weight?
The guidelines do not mean everyone must switch treatment each year. They help your clinician answer five questions: Is glucose controlled safely? Are your heart and kidneys protected? Does treatment support your weight goal? Is insulin causing lows or unnecessary burden? Would a continuous glucose monitor help? Your next step is a structured treatment review—not changing metformin or insulin yourself.
Answer by Dr. Albana Greca, MD, MMedSc
Hi Asim,
ADA is the American Diabetes Association, and EASD is the European Association for the Study of Diabetes. Their guidance is written mainly for professionals, but the main idea is simple: treatment should fit the person, not force everyone through the same medication sequence.
Think of them as a checklist:
A yearly update matters only when one of these answers suggests that your current plan can be improved.
For many nonpregnant adults, HbA1c below 7% is a common starting goal. It may be higher when hypoglycemia, frailty, several illnesses, or treatment burden is present, and lower when it can be reached safely.
When CGM is used, many adults aim to spend more than 70% of the day between 70 and 180 mg/dL while minimizing time below 70. HbA1c, fasting and after-meal patterns, and low-glucose episodes should be reviewed together.
The modern approach asks whether a medicine also helps the heart, kidneys, weight, fatty liver, and hypoglycemia risk. If you have heart failure or chronic kidney disease, an SGLT2 inhibitor may be considered for organ protection even when HbA1c is near target. With cardiovascular disease, obesity, or difficulty losing weight, a GLP-1 receptor agonist or dual GIP/GLP-1 medicine may be discussed.
These options are not suitable for everyone. Kidney function, digestive symptoms, dehydration risk, previous pancreatitis or gallbladder disease, other medicines, availability, cost, and preferences must be reviewed.
Not automatically. Metformin may remain useful when tolerated and kidney function permits. Insulin is not a failure; many people need it as type 2 diabetes progresses.
However, insulin may cause weight gain or hypoglycemia. If another medicine is added, the insulin dose may need reassessment. Repeated overnight lows, large bedtime-to-morning drops, or rising basal doses without better daytime control may mean the regimen needs restructuring. Never stop basal insulin without a written plan.
The guidelines treat excess weight as a health condition, not a lack of willpower. Food, activity, sleep, medicines, emotional health, and access all matter. Clinicians should prioritize treatments that are weight neutral or support weight loss when appropriate.
Structured programs, obesity medicines, and metabolic surgery may also be considered according to BMI, health conditions, risks, cost, and preferences. Even modest sustained weight loss can improve glucose, blood pressure, fatty liver, mobility, and medicine needs. Use our BMI and waist-to-height calculator as a screening tool.
Because you use insulin, CGM should be discussed. A sensor can show glucose direction, overnight patterns, meal responses, and hidden lows. It may improve HbA1c and time in range and reduce hypoglycemia.
CGM does not manage diabetes by itself. You need training on alerts, trend arrows, sensor errors, finger-stick confirmation, and how the data should change insulin decisions. Cost, access, skin reactions, and comfort also matter.
Diabetes care includes blood pressure, cholesterol and statin treatment, kidney function and urine albumin, eye examinations, foot and nerve checks, smoking, vaccinations, sleep, dental health, and fatty liver risk. A medicine that lowers HbA1c but does not fit your organ risks may not be the best option.
Bring your medicine packages, insulin doses, glucose records, low-glucose history, weight trend, and questions. A blood sugar log can make the review more useful.
Do not stop insulin or begin a new diabetes or weight-loss medicine without medical guidance. Seek prompt advice for repeated glucose below 70 mg/dL or persistent readings around 300 mg/dL or higher. Seek emergency care for severe hypoglycemia, unconsciousness, vomiting, difficult breathing, confusion, high ketones, or a meter displaying “HI.”
You do not need to memorize the guidelines. Ask your clinician to turn them into one written plan covering your glucose target, heart and kidney protection, weight goal, insulin safety, CGM choice, screening schedule, cost, and next review date.
Educational safety note: This answer is for general diabetes education only. It does not replace personal medical advice, diagnosis, or treatment. Do not start, stop, or change metformin, insulin, SGLT2 inhibitors, GLP-1-based medicines, supplements, diet, or exercise without speaking with your healthcare provider.
Last reviewed: July 2026.
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