1. Treatment algorithm for management of type 2 diabetes mellitus
Treatment algorithm for management of type 2 diabetes mellitus. Patients diagnosed with type 2 diabetes, either by fasting glucose, oral glucose tolerance testing, or A1c measurement, should have diabetes education that includes instruction on medical nutrition therapy and physical activity. Most patients newly diagnosed with type 2 diabetes have had subclinical or undiagnosed diabetes for many years previously and should be evaluated for diabetic complications (retinal exam, test for excess protein or albumin excretion in the urine, and clinical evaluation for peripheral neuropathy and vascular insufficiency); common comorbidities (hypertension and dyslipidemia) should be treated. Metformin is the consensus first line of therapy and should be started at the time of diagnosis. Failure to reach the glycemic target, generally A1c ≤7% within 3-4 months, should prompt the addition of a second oral agent. Reinforce lifestyle interventions at every visit and check A1c every 3 months. Treatment may escalate to metformin plus 2 oral agents or metformin plus insulin, if necessary.
Source: Endocrine Pancreas and Pharmacotherapy of Diabetes Mellitus and Hypoglycemia, Goodman and Gilman's Manual of Pharmacology and Therapeutics, 2e
Citation: Hilal-Dandan R, Brunton LL. Goodman and Gilman's Manual of Pharmacology and Therapeutics, 2e; 2016 Available at: Accessed: October 18, 2017
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