2012 ADA Clinical Practice Guidelines Therapies for DM- Type 2 Sanaz Sakiani, MD Endocrinology Fellow Journal Club 2-16-12 2012 ADA Clinical Practice Guidelines Therapies for DM- Type 2

Therapies for DM2 - Recommendations At the time of DM2 diagnosis, initiate metformin therapy along with lifestyle interventions (MNT and exercise), unless metformin is contraindicated.

Therapies for DM2 - Recommendations 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.

Therapies for DM2 - Recommendations If noninsulin monotherapy at maximal tolerated dose does not achieve or maintain the A1C target over 3-6 months, add a second oral agent, a GLP-1 receptor agonist, or insulin. If A1C targets are not achieved, treatment intensification is based on the addition of another agent from a different class Meta-analyses suggest that overall, each new class of non-insulin agents added to initial therapy lowers the A1C by around 0.9-1.1%

Therapies for DM2 - Recommendations ADA and EASD have partnered on new guidance for individualization of use of medication classes and combinations in patients with DM2. These guidelines will be published in early 2012