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Advancing oral treatment for Type 2 diabetes

Your obese type 2 diabetes patient, who is 58 years old, has been on metformin, but recent HbA1C levels are around 8.2%, despite attempts at controlling diet and exercise. The patient realizes something must be done and would very much like to maximize A1C reductions with the next option, hoping to achieve levels closer to a goal of 7.0%, if not below that, to avoid having to add multiple further medications. However, the patient hopes to avoid injectable medications if they are not completely necessary. The patient would also like to lose weight.

What medication would you recommend next?

Would your recommendation differ if the patient had a history of atherosclerotic cardiovascular disease?

How would you help this patient stay compliant with your prescribed treatment regimen?

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Non-insulin treatment for A1C reduction in Type 2 diabetes

Current ADA guidelines recommend:

• A1C goal for nonpregnant adults of <7% (53 mmol/mol) without significant hypoglycemia is appropriate.
• Achievement of lower A1C levels than 7% may be acceptable, and even beneficial, if achieved safely without significant hypoglycemia or other adverse effects.
• A1C goals of <8% [64 mmol/mol] or higher may be appropriate for patients with limited life expectancy, or where the risks outweigh the benefits.

Current ADA guidelines recommend that the medication regimen and medication-taking behavior should be reevaluated at regular intervals (every 3–6 months) and adjusted as needed to incorporate specific factors that impact treatment choice.

How long after starting a diabetes medication do you wait to see if the patient needs to switch or escalate to other non-insulin anti-diabetic treatments?

What are the key considerations when deciding to switch or escalate to other non-insulin anti-diabetic treatments?

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