[Clinical practice guidelines in type 2 diabetes mellitus: similarities and discrepancies]

A careful analysis of the therapeutic recommendations of the main clinical practice guidelines (CPGs) reveals that, although they appear to be highly diverse both in their form and content, they share more similarities than discrepancies. Metformin is the recommended first-line drug both in monotherapy and double oral therapy in the 5 CPGs included in this study. Sulphonylureas are also the standard of care for all the guidelines on dual oral therapy, although they also include glitazones and DPP-4 inhibitors at this stage as well, as a first or a second-line drug. Moreover, there is unanimous agreement on the recommendation of the use of insulin by all the CPGs when anti-diabetes combinations prove ineffective, initially advising the application of a basal insulin dose in conjunction with metformin. Other therapeutic alternatives are given less coverage. In relation to the aim of achieving good glycemic control, there are discrepancies amongst the different CPGs, as one recommends target HbA1c ≤ 6.5% and others < 7%. Finally, one recommends target HbA1c 6.5% in the initial phases and < 7.5% in advanced cases.