By vgreene, 10 January, 2019 If SLGT2-I not tolerated or contraindicated or if eGFR less than adequate, add GLP-1 RA w/ proven CVD benefit:4
By vgreene, 10 January, 2019 If CKD: Consider use of SGLT2-I or GLP1-1 RA shown to reduce CKD progression, CV events, or both [C]
By vgreene, 10 January, 2019 If high risk of HF or coexisting HF and eGFR adequate, prefer SGLT2-I [C]:
By vgreene, 10 January, 2019 empagliflozin > canagliflozin (based on modestly stronger evidence, although both reduced HF and/or CKD progression in CV outcome trials)
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 glucose-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]
By vgreene, 10 January, 2019 If HbA1C ≥1.5% above glycemic target: Consider initiating dual tx (metformin + 2nd agent) [E]