Photo: Professor Peter Rossing, Head of Research, is one of the experts behind the new recommendations on type 2 diabetes, presented on the final day of the EASD congress in Milano.
Good long-term blood glucose control is not always enough. More people with type 2 diabetes need treatment that protects their heart and kidneys, and care needs to take greater account of each person’s living circumstances.
These are central messages in the updated guidance on the management of type 2 diabetes in adults, presented by the American Diabetes Association (ADA) and the European Associa-tion for the Study of Diabetes (EASD) on the final day of the EASD congress. The guidance was last updated in 2022.
In Denmark, the recommendations come at a time when a growing number of people need treatment. According to the report “Diabetes in Denmark”, published by Steno Diabetes Cen-ter Copenhagen, 6.3% of all men and 5% of all women had been diagnosed with type 2 diabe-tes in 2024. In 1996, the figure was 1.1% for both sexes.
One of the experts behind the new recommendations is Peter Rossing, Professor and Head of Research at Steno Diabetes Center Copenhagen. He believes the recommendations can help guide the Danish healthcare system as it addresses this challenge.
“These guidelines take a more holistic approach to treating people with type 2 diabetes. We recommend changes to medication for some groups of patients, but there is also a stronger focus on individual lifestyles, social circumstances and vulnerability. If we succeed in imple-menting these guidelines, we can also help reduce health inequalities,” says Peter Rossing.
He emphasises that living circumstances influence people’s behaviour and their ability to ac-cess and use healthcare services. A healthy diet, sleep and physical activity, avoiding tobac-co and substance use, psychological support and weight management remain fundamental elements of care. However, the organisations behind the recommendations are now calling for more psychological support and greater emphasis on individually tailored guidance on diet, exercise and weight management.
Good blood glucose control must not lead to complacency
There is also considerable scope to improve treatment by strengthening organ protection, as the new recommendations propose. The guidance calls for more people to be offered GLP-1 receptor agonists and SGLT2 inhibitors. Several studies have shown that these medicines benefit people with type 2 diabetes who are at risk of cardiovascular disease, kidney disease or heart failure.
“The new guidelines recommend using SGLT2 inhibitors earlier in the treatment of more pa-tients. They can also be combined with metformin for people at high risk or with poor blood glucose control. Nor do doctors necessarily have to choose between GLP-1 medicines and SGLT2 inhibitors, which used to be the norm,” says Peter Rossing.
Metformin has been used for more than 50 years and has traditionally been the first choice among glucose-lowering treatments because it effectively lowers long-term blood glucose levels, carries a low risk of hypoglycaemia, has a good safety profile and is inexpensive. However, Peter Rossing believes a change in mindset is needed among doctors, whose fo-cus has largely been on long-term blood glucose control.
“Metformin remains a good option for lowering blood glucose, but we need to move away from the idea that good blood glucose control alone is enough. Many people with good blood glu-cose control should receive GLP-1 medicines or SGLT2 inhibitors to protect their organs.”
He points out that around half of the people receiving diabetes treatment in general practice in Denmark have good blood glucose control. More than a quarter have cardiovascular disease or kidney disease that requires treatment to protect their organs.
More people are receiving treatment, but substantial differences remain
Denmark has already moved in the direction set out by the recommendations. Figures from the Danish Diabetes Database’s 2025 annual report show that 59% of people with type 2 dia-betes and established cardiovascular disease receive an SGLT2 inhibitor or a GLP-1 recep-tor agonist. In 2022, the proportion was 43%.
However, this progress masks substantial differences. In the Capital Region of Denmark, 85% of patients who have attended hospital for diabetes care within the past 18 months re-ceive this treatment, compared with 52% of those who have not.
There are also geographical differences in how many people are tested for signs of kidney damage. In Region Zealand and the Capital Region of Denmark, respectively, 62% and 66% of people with diabetes who had not attended hospital had undergone a urine albumin test within the past 15 months. In Denmark’s other three regions, the figure was 81%.
“Denmark has been making progress for some years, but access to these treatments still varies too much across the country. We need to engage with general practitioners and sup-port them with tools so that everyone with type 2 diabetes has their risk of complications as-sessed and their treatment adjusted,” says Peter Rossing.
He also hopes that the cost of medication will become less of a barrier.
“The data show that we are getting better at offering treatment to protect organs to the right patients in Denmark. At the same time, one of the SGLT2 medicines will soon come off pa-tent, which will lead to a substantial price reduction. Hopefully, this will help remove a barrier that limits how many people, and who, we can offer this treatment to,” says Peter Rossing, adding:
“We are committed to reducing health inequalities, and if we can ensure that more people re-ceive the best treatment it would be a major step in the right direction.”
It may also make economic sense. Over the past year, two health economic analyses using Danish cost data have examined these treatments. One looked at greater use of SGLT2 in-hibitors in people with chronic kidney disease. The other focused on treatment with the GLP-1 medicine semaglutide in people with both type 2 diabetes and chronic kidney disease. Both analyses suggest that these approaches could give people more years in good health while reducing overall healthcare costs in the longer term, largely because fewer people would de-velop kidney failure.
More people could benefit from a glucose sensor
Wider use of diabetes technology is another prominent theme in the new recommendations. The professional associations behind them also suggest that more people with type 2 diabe-tes could benefit from glucose sensors and insulin pumps. The guidance recommends that continuous glucose monitoring is considered, particularly for people treated with insulin.
These recommendations are closely aligned with political signals in Denmark that more peo-ple with type 2 diabetes should have access to the latest diabetes technology.
The joint ADA/EASD guidance does not automatically apply in Denmark, where doctors fol-low national guidelines. However, Peter Rossing expects the Danish guidelines to be updated soon.
“Following shared guidance puts us in a much stronger position. The recommendations are based on the same studies, and if we can speak with one voice, we have a better chance of improving care for a broader group of people with type 2 diabetes,” says Peter Rossing.