| |
2009 [12] |
2012 [11] |
| General |
Consensus approach to help healthcare providers choose the most appropriate interventions for patients with T2DM. Lifestyle intervention is important. |
Less prescriptive, patient centered. Patient and disease factors drive decision making. Age and comorbidities may impose constraints on disease management. Lifestyle intervention is important. |
| Glycemic target (A1C) |
<7.0% for most patients |
<7.0% for most patients
<6.5% for patients with short disease duration, long life expectancy, no significant CVD
7.5%-8.0% for patients with limited life expectancy, advanced complications, comorbidities, history of hypoglycemia, and difficulty maintaining glycemic target. |
| Initial drug therapy |
Metformin
If symptomatic hyperglycemia persists, rapid addition of other diabetes medications should be considered. |
Metformin
If A1C ≥ 9.0%, initiate with 2 noninsulin drugs or insulin.
If A1C ≥ 10.0%, initiate insulin |
| Alternative to metformin if contraindicated or not tolerated |
Not addressed |
SU, pioglitazone, DPP-4 inhibitor. (GLP-1 receptor agonist if weight loss is essential) |
| 2-drug combinations |
Metformin+SU
Metformin+basal insulin |
Metformin+SU
Metformin+TZD
Metformin+DPP-4 inhibitor
Metformin+GLP-1 receptor agonist
Metformin+insulin |
| Additional Rx needed to reach glycemic goal |
Start or intensify insulin therapy |
3-drug combinations (Figure 1) and/or insulin |
