By vgreene, 10 January, 2019 Consider adding the other class (GLP-1 RA and/or SGLT2i) w/ proven CVD benefit4
By vgreene, 10 January, 2019 Along w/ metformin, incorporate either a GLP-1 RA w/ proven CVD benefit or a SGLT2i w/ proven CVD benefit (if eGFR adequate) [A]:
By vgreene, 10 January, 2019 SGLT2i w/ proven CVD benefits:4 empagliflozin > canagliflozin (based on modestly stronger evidence)
By vgreene, 10 January, 2019 Metformin is preferred initial mono-tx; add other agents, incl insulin, to metformin; don’t delay intensifed tx ; 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 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]