The American Diabetes Association has released its 2017 “Standards of Medical Care in Diabetes.” An overview of the group’s guidance on pharmacologic therapy for type 2 diabetes is available in the Annals of Internal Medicine.
Among the recommendations:
Metformin is still the preferred first-line regimen and should be prescribed for most patients at the time of diagnosis, provided it’s not contraindicated. Starting at 500 mg once or twice daily may help minimize gastrointestinal side effects, followed by gradual titration up to 2 g/daily.
If metformin is contraindicated or poorly tolerated, clinicians should use a patient-centered approach to choose from the other available agents. Tables detailing all FDA-approved diabetes medications, including their costs, are provided.
Dual therapy should be considered for asymptomatic patients with hemoglobin A1c levels of 9% or greater.
Insulin may be advisable for symptomatic patients or those with an HbA1c of 10% or greater or blood glucose of 300 mg/dL or greater.
Annals of Internal Medicine article (Free abstract)
Background: NEJM Journal Watch General Medicine coverage of ADA’s 2016 “Standards of Medical Care in Diabetes” (Your NEJM Journal Watch registration required)