Stepwise Approach to Selecting Treatments for Type 2 Diabetes

Pharmacist's Letter/ Prescriber's Letter June 2007, Vol 23, No 230622

 

  1. Diagnosis of Type 2 DM

     
  2. Counsel regarding lifestyle modification (Weight Loss, Exercise); Expect decrease in HbA1C 1-2%) and initiate Metformin (glucophage) 500 mg PO QD or BID; titrate to 850 to 1000 mg BID (expect decrease in HbA1c 1.5%)

     
  3. If HbA1c 7% or greater 3 months later:
  1. If HbA1c 7% or greater 3 months later:
  1. If HbA1c 7% or greater 3 months later:
  1. If HbA1c 7% or greater 3 months later:

 

When prandial rapid or very-rapid acting insulin is added, insulin secretagogues such as the sulfonylureas or the glinides (repaglinide, nateglinide) should be discontinued.