Pharmacological Therapy for Hyperglycemia in Type 2 Diabetes
- Metformin, if not contraindicated and if tolerated, is the preferred initial pharmacological agent for type 2 diabetes. A
- In newly diagnosed type 2 diabetic patients with markedly symptomatic and/or elevated blood glucose levels or A1C, consider insulin therapy, with or without additional agents, from the outset. E
- If noninsulin monotherapy at maximum tolerated dose does not achieve or maintain the A1C target over 3 months, add a second oral agent, a glucagon-like peptide 1 (GLP-1) receptor agonist, or insulin.A
- A patient-centered approach should be used to guide choice of pharmacological agents. Considerations include efficacy, cost, potential side effects, effects on weight, comorbidities, hypoglycemia risk, and patient preferences. E
- Due to the progressive nature of type 2 diabetes, insulin therapy is eventually indicated for many patients with type 2 diabetes. B
Reference: Link for Executive Summary, Standards of Medical Care in Diabetes—2014 by American Diabetes Association. http://care.diabetesjournals.org/content/37/Supplement_1/S5.full
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