Standards of Care Section 8 – Approaches to Glycemic Treatment
Insulin Therapy for Type 1
This updated version of Meds Management includes more detailed information on insulin therapy for Type 1s. They note that sensor-augmented insulin pump therapy with the threshold suspend feature reduced nocturnal hypoglycemia without increasing A1c (for type 1s in a 3 month randomized trial). The FDA approved the first hybrid closed-loop pump system, since the literature supports its safety and efficacy.
Investigational Agents for Type 1s
Type 2 Management Strategies – Stepwise Approach to Pharmacologic Management of Type 2 Diabetes – 2018
Pharmacologic Approaches to Glycemic Treatment 2018. This hyperglycemia road map details strategies to achieve glucose control for both Type 1 and Type 2 Diabetes. Section 8 of Standards of Care, Dec 2018.
According to the ADA 2018 Standards, section 8, Metformin therapy should be started along with lifestyle Management at diagnosis of type 2 Diabetes (unless contraindicated). Metformin is effective, safe, inexpensive and may reduce risk of CV events and death.
If A1c target is not achieved after 3 months, consider metformin and any one of the six preferred treatment options based on drug specific effects and patient factors.
If A1c target is still not achieved after 3 months on metformin, and the patient has CV Disease, consider adding a second agent with evidence of cardiovascular risk reduction (based on drug specific effects and patient factors).
If A1c target is still not achieved after 3 months, combine metformin plus two other agents for a three-drug combination.
If A1c target is still not achieved after 3 months, add combination injectable therapy to the three-drug combination.
For all steps, consider including medications with evidence of CV risk reduction, based on drug specific effects and patient factors.
Medication Therapy Based on A1c
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