By vgreene, 10 January, 2019 SGLT2-I w/ proven CVD benefits:4 empagliflozin > canagliflozin (based on modestly stronger evidence)
By vgreene, 10 January, 2019 GLP1-RA w/ proven CVD benefits:4 liraglutide > semaglutide > exenatide ER (based on strongest evidence)
By vgreene, 10 January, 2019 Metformin is preferred initial mono-tx; add other agents, incl insulin, to metformin; don’t delay intensifed 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]
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