The treatment approach to type 2 diabetes should begin with an assessment of cardiovascular disease (CVD) status, other comorbidities, and patient preferences, according to a draft of the upcoming 2018 joint consensus statement from the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD).The final version of the 2018 update to the current 2015 ADA/EASD Management of Hyperglycemia in Type 2 Diabetes statement (Diabetes Care.2015;38:140-149) will be presented on October 5, 2018 at the EASD annual meeting in Berlin and will be published in Diabetes Care and Diabetologia.A preview of the draft document was presented in a 2-hour symposium on June 26 here at the American Diabetes Association (ADA) 2018 Scientific Sessions. A live webcast of the session is now available and comments can be submitted to email@example.com until midnight on July 2.The statement will aim to help clinicians navigate the increasingly complex options for management of hyperglycemia in type 2 diabetes, with particular emphasis on data published since 2014, including those suggesting cardiovascular benefit for the sodium-glucose cotransport-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists."The focus of this consensus report is not on what an individual's glycemic target should be or on how to select individualized goals, but rather how to achieve the individual patients' glycemic target taking into account patient factors and the ever-increasing choice of therapies available for glycemic control," said co-author Judith Fradkin, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, Maryland.The draft document still recommends metformin as first-line therapy, but now favors the injectable GLP-1 agonists or SGLT2 inhibitors as second-line therapy over insulin, depending on underlying patient characteristics and other issues such as affordability/accessibility of the drugs.Observers generally reacted well to the draft document.In an interview, Silvio E. Inzucchi, MD, of Yale University School of Medicine, New Haven, Connecticut, who co-chaired the 2015 and 2012 ADA/EASD statement writing panels but wasn't involved in the 2018 version, said that at the time of the prior statements "there was a paucity of good clinical trial evidence on which to base decision-making, particularly regarding CVD...So it was a little unsatisfying because all it said was start with metformin and then do something else."But now, "over the last 2 to 3 years, we have a growing dataset upon which we can actually further strategize our patient-centered approaches to care," he explained.Others were pleased that the document also clearly states the limitations of the evidence, and that there will be some good practical advice for primary care physicians, who are increasingly having to manage type 2 diabetes. This will include a graphic clearly indicating which type 2 diabetes agents should be stopped, or have their doses reduced, when therapy is intensified. And the cost of drugs is addressed, with the acknowledgement that it may be necessary to use a generic type 2 diabetes agent or older insulin if that is all a patient can afford.