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 Monitor A1C: 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 A1C ≥1.5% (12.5 mmol/mol) 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 A1C ≥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, choose agents demonstrating CV safety (but avoid TZD in the setting of HF):