By vgreene, 10 January, 2019 If DPP4-I not tolerated/contraindicated (or pt already on GLP-1 RA): Consider cautious addition of SU (choose later gen, w/ lower hypoglycemia risk), TZD,5 or basal insulin
By vgreene, 10 January, 2019 Along w/ metformin: Incorporate either a GLP-1 RA (w/ good efficacy for wt loss; presently evidence for semaglutide > liraglutide > dulaglutide > exenatide > lixisenatide) or SGLT2-I4
By vgreene, 10 January, 2019 Metformin is preferred initial mono-tx; add other agents, incl insulin, to metformin; don’t delay intensified tx; GLP-1 RA preferred to insulin in most pts; reassess and modify tx every 3-6mo as needed
By vgreene, 10 January, 2019 Re-eval med regimen every 3-6mo and adjust prn to account for pt factors and regimen complexity [E]
By vgreene, 10 January, 2019 Don’t delay intensified tx for pts not meeting tx goals [B]; in most pts requiring greater gluclose-lowering effect of injectable med, GLP-1 RA preferred over insulin [B]
By vgreene, 10 January, 2019 Monitor HbA1C: at least twice yearly if pt meeting goals/stable glycemic control; quarterly if not meeting goals or tx has changed; point-of-care testing allows for more-timely tx changes [E]