Analyse critique du consensus ADA/EASD 2009Â : ''Back to the past and lost in translation''

Consensus or disensus? That is the question! On behalf of the ADA/EASD an Expert Committee published in 2009 an algorithm with 2 tiers. The main strength of this consensus statement consisted to recommend an early insulin therapy in the time course of type 2 diabetes. Insulin should be initiated first with a basal regimen and further completed with more intensive protocols, if necessary. By contrast, one of the weakness concerns the management with oral hypoglycaemic agents that are restricted to metformin and sulfonylureas in tier 1. The extension to pioglitazone and GLP-1 analogs is only evoked in tier 2. Such medications as gliptins, glinides, rosiglitazone and alpha-glucosidase inhibitors are totally ignored both in tiers 1 and 2. In addition, the authors recommend starting lifestyle and pharmacological interventions, concomitantly, as soon as the disease has been detected. Finally, the reader experiences some difficulties to know whether the 7% HbA1c value was chosen for defining a target or an interventional threshold. In short, and except for the insulin recommendations, the reader is left with a mixed impression of uncertainty that can be summarized by the famous sentence attributed to Arnaud Almaric, abbot of Cîteaux, during the Albigensian crusade: « God will know his own ».