[Towards new recommendations for the treatment of type 2 diabetes? An expert's point of view].

Type 2 diabetes is growing rapidly, as its cost and the daily concern of general practitioners. Many treatment advances are now available and many more are in development. Currently the drugs based on the "incretin" phenomenon are the more recent and innovative (tree different DPP-inhibitors and two GLP1 analogues) with a specific benefit, no hypoglycemic attacks and a better body weight control. Thus the recommendations for the management of hyperglycaemia are becoming increasingly complex and difficult to write. The first recommendation is to not drift HbAlc, the second, is to use metformin as first line treatment for most patients in the absence of intolerance. The delay in passing to combination (two 0ADs) remains excessive; it must be done without delay at 6.5 or 7% HbA1c. There are four possible combinations today (acarbose, sulfonylureas, gliptins, glitazones). Then, one can choose between triple oral therapy, insulin and GLP1 analogues. Deciding who needs what becomes more difficult regarding the different phenotypes and specificities of each patient, the economic considerations and the benefit/risk of the different classes or strategies. Thereby, recommendations cannot enter so many details and strategies. The need for continuing medical education and the referral to diabetologist more often is becoming essential.