By vgreene, 5 January, 2017 If not at target1 after 3mo of mono-tx, assess med-taking behavior, consider dual tx; if CV dz, consider empagliflozin or liraglutide (or possibly canagliflozin)
By vgreene, 5 January, 2017 If pt has established atherosclerotic CVD, consider empagliflozin or liraglutide1 [B]
By vgreene, 5 January, 2017 If pt not achieving glycemic goals, do not delay drug intensification, incl insulin tx [B]
By vgreene, 5 January, 2017 If no ASCVD and noninsulin mono-tx at max-tolerated dose doesn’t achieve A1C target after 3mo, add additional oral agent based on drug-specific and pt factors [A]
By vgreene, 5 January, 2017 Metformin is preferred initial mono-tx; consider combo tx if A1C ≥9%; consider combo insulin injectable tx if A1C ≥10%/blood glucose ≥300 mg/dL/marked sx
By vgreene, 5 January, 2017 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, 5 January, 2017 If 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, 5 January, 2017 If A1C ≥9%, consider initiating dual tx (metformin + 2nd agent); consider insulin as 2nd agent if severe hyperglycemia, sx present, or any catabolic features (wt loss, ketosis)
By vgreene, 5 January, 2017 Metformin is preferred initial agent, (if tolerated, not contraindicated)1,2 [A] w/ lifestyle modifications
