The main goal of treating diabetes is to minimise the probability of complications while maximising the patient’s quality of life.
When a new diagnosis of T2DM is made, a determination of how the patient is treated is based primarily on HbA1C levels AND whether or not they have complications. All newly diagnosed diabetics should be screened for complications at the first checkup after diagnosis. The best initial therapy in a new T2DM patient is metformin (unless contraindicated).
Target HbA1C is ≤ 6.5%, especially in young patients. The target may be increased to 7.0% in older patients or patients taking sulfonylureas due to the risk of hypoglycemia. A follow-up HbA1C is ordered every 3 – 6 months.
| HbA1C level (%) | Treatment |
|---|---|
| ≤ 7.5 | Monotherapy + lifestyle |
| 7.6 – 9 | Dual therapy |
| ≥ 9 without complications | Insulin (NPH +/- soluble insulin) |
| ≥ 9 with complications | Triple therapy |
- Prescribing OGLAs
- HbA1C <7.5%:
- HbA1C > 7.5%:
- Metformin + Sulfonylurea
- Metformin + DPP-4 inhibitor
- Metformin + Thiazolidinedione
- Metformin + SGLT-2 inhibitor
- Persistent HbA1C >7.5%: Metformin +
- Metformin + DPP-4 inhibitor + Sulfonylurea
- Metformin + Thizolidedinedione + Sulfonylurea
- Metformin + Sulfonylurea + SGLT-2 inhibitor
- Metformin + Thiazolidedinedione + SGLT-2 inhibitor
- Insulin therapy