TREATMENT ALGORITHM for TYPE 2 DIABETES

Education*/Nutrition/Exercise/HBGM

 


Nonpharmacological measures inadequate
FPG>140

A1C>7%

Usual first-line therapies

Alternative first-line therapies

Metformin

Sulfonylurea

AGIs

(insulin-resistant, overweight or
dyslipidemic)

(insulinopenic or lean)

(postprandial hyperglycemic)

 

Monotherapy adequate
FPG <140

A1C 7%

Continue

(insulin-resistant or
impaired)

renally

Meglitinides

Insulin

(sulfa allergic, erratic meals)

(if BS >300 and patient symptomatic)

Monotherapy inadequate
FPG >140

Thiazolidinediones

A1C >7%

Initiate oral combination therapy

Metformin + Sulfonylurea

Alternative combination therapy

Thiazolidinedione + Sulfonylurea

 

Metformin + Thiazolidinedione
(if patient very insulin resistant)
Metformin + Meglitinide
AGIs + any other agents

Combination therapy inadequate

FPG >140

A1C >7%

Consider triple therapy

Add/change to insulin therapy
Consider referral to specialist

HBGM=home blood glucose monitoring

FPG=fasting plasma glucose
A1C=Hemoglobin A1C
AGI (alpha-glucosidase inhibitors)=acarbose & miglitol
Meglitinides=repaglinide & nateglinide
Thiazolidinidiones=rosiglitizone & pioglitazone

*Refer to local diabetes education programs or diabetes

educators
** If glucose is consistently >250 and patient is symptomatic,
may initiate therapy earlier

(UWHC Diabetes Clinic 608-263-7741)

For appropriate screening and preventive care see the Essential Diabetes Mellitus Care Guidelines at www.dhfs.state.wi.us/health/diabetes
For diagnosis and management of dyslipidemia see the Dyslipidemia guideline at www.hosp.wisc.edu/crit/guides/dyslipidemias.htm
Revised 2/2002