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
A1C=glycated hemoglobin; CVD=cardiovascular disease; DPP-4=dipeptidyl peptidase-4; GLP-1=glucagon-like peptide–1; SU=sulfonylurea; T2DM=type 2 diabetes mellitus; TZD=thiazolidinedione.
Table 1: Comparison of ADA/EASD 2009 and 2012 Treatment Recommendations