A patient with Type 2 diabetes may not respond to monotherapy with an oral hypoglycemic agent.
(1) the oral agent being used as initial monotherapy
(2) fasting glucose and hemoglobin A1c after a change in therapy
Initial Oral Agent
Second Oral Agent To Consider Adding
metformin, thiazolidinedione, DPP-4 inhibitor
sulfonylurea, thiazolidinedione, meglitinide, DPP-4 inhibitor
sulfonylurea, metformin, meglitinide
In addition, encourage weight loss and exercise.
Targets for adequate control:
(1) fasting glucose < 140 mg/dL
(2) hemoglobin A1c < 8.0%
If targets are met then continue therapy.
If targets are not met then consider:
(1) adding a third oral agent
(1a) avoid using a meglitinide with a sulfonylurea
(1b) consider a GLP-1 mimetic in a patient taking metformin and a sulfonylurea
(2) adding an intermediate to long-acting insulin at bedtime (BIDO regimen)
(3) switching to insulin therapy alone
(4) referring to a diabetes specialist
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Purpose: To evaluate a patient with Type 2 diabetes who is poorly controlled on a sngle oral hypoglycemic agent.
Specialty: Endocrinology, Clinical Laboratory
Objective: dosage adjustments, failure handling and therapy escalation
ICD-10: T38.3, E11.8, E11.9,