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 further tx intensification needed (that is, HbA1c still above target) or pt unable to tolerate GLP-1 RA or SGLT2-I, choose agents demonstrating CV safety:
By vgreene, 10 January, 2019 TZD (low dose may be better tolerated, but less well studied for CVD effects)
By vgreene, 10 January, 2019 Consider adding the other class (GLP-1 RA and/or SGLT2-I) w/ proven CVD benefit4
By vgreene, 10 January, 2019 Along w/ metformin, incorporate either a GLP-1 RA w/ proven CVD benefit or a SGLT2-I w/ proven CVD benefit (if eGFR adequate) [A]