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 further tx intensification needed (that is, HBA1c still above target) or pt unable to tolerate GLP-1 RA or SGLT2i, choose agents demonstrating CV safety:
By vgreene, 10 January, 2019 TZD (low dose may be better tolerated, but less well studied for CVD effects)