By vgreene, 10 January, 2019 If HbA1C ≥1.5% above glycemic target: Consider initiating dual tx (metformin + 2nd agent) [E]
By vgreene, 10 January, 2019 If evidence of catabolism (wt loss, ketosis), sx of hyperglycemia (ie, polyuria, polydipsia), and/or HbA1C ≥10% and/or blood glucose ≥300 mg/dL: Consider initiating combo insulin injectable tx, w/ or w/o additional agents [E]
By vgreene, 10 January, 2019 Metformin is preferred initial agent, (continue as long as tolerated/not contraindicated)1,2 [A] w/ lifestyle changes, incl wt mgmt and physical activity
By vgreene, 10 January, 2019 If HBA1c still above target despite addition of above agents, consider adding:
By vgreene, 10 January, 2019 basal insulin (w/ lower risk of hypoglycemia); degludec/glargine U300 < glargine U100/determir < NPH insulin
By vgreene, 10 January, 2019 If HbA1c still above target, consider adding more agents (per the following sequence) to lower HBA1c: