Patient Management | Type 2 Diabetes Poorly Controlled | Single Oral Hypoglycemic Agent

 

Parameters:

(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
sulfonylurea	metformin, thiazolidinedione, DPP-4 inhibitor
metformin	sulfonylurea, thiazolidinedione, meglitinide, DPP-4 inhibitor
thiazolidinedione	sulfonylurea, metformin, meglitinide
meglitinide	metformin, thiazolidinedione

 

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