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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?

  • 2 weeks 5 days
    Always encourage pt healthy diet & consult with dietician!
  • 1 month
    Can also consider make adjustments based on their Blood glucose readings !
  • 1 month
    Can also consider make adjustments based on their Blood glucose readings !
  • 1 month 2 weeks
    Encourage healthy life style, diet and physical activity in patient
  • 1 month 3 weeks
    After initiating a non-insulin drug in a newly diagnosed DM pt, I would call pt within a week to see if able to procure medication if there are insurance issues and monitor for any side effects. Teach pt to recognize signs and symptoms of hypoglycemia and how to manage it. Emphasize importance of lifestyle modification, diet, exercise, smoking. Check daily capillary blood sugar levels. Refer pt to dietician if interested. If pt doing well re-evaluate in 1 month and A1C, CMP in 3 months. Advice to see ophthalmologist for diabetic eye check. If pt doing well follow up every 3 months.
  • 1 month 3 weeks
    Initially after three months and if HBA1C level is at goal every four months.
  • 1 month 3 weeks
    3 months if a1c is out of range, 6 months if in range. Meds determined by cost, side effects, pt willingness to take.
  • 1 month 3 weeks
    3 months if a1c is out of range, 6 months if in range. Meds determined by cost, side effects, pt willingness to take.
  • 1 month 3 weeks
    I reevaluate in three months before making changes, unless patient has any issues with the medication.
  • 2 months 2 weeks
    If pt is on insulin then advise frequent visits every 1-2 weeks for insulin titration
  • 2 months 3 weeks
    Agree with comments diet, life style changes , exercise should be emphasized for patient
  • 2 months 3 weeks
    I would see pt every 4 weeks initially and check BG/ HgbA1c
  • 3 months
    Recheck patient in 4 weeks
  • 3 months
    When starting new medicine will have patient back in 4 weeks to see how they are doing with medication
    Will review blood glucose record if they are keeping one
    If tolerating medication will make adjustments based on the last HbA1C, the expected HbA1C reduction of the new medication. May start another agent at that point
    Usually checking HbA1C every 3 months
    Cost is major consideration in selection of medications and other medical conditions the patient may have
  • 3 months
    I wait 4 months before do an a1c, i adjust or change meds if the a1c is not at 6.5
  • from PA Unite 3 months
    Usually every 3 months, but also highly encourage meeting with a dietitian for medical nutrition therapy and diabetes diet education (as well as direct him/her to the American Diabetes Association website for recipes and help with meal-planning)
  • from Pharmacist Society 3 months
    At least 3 months try on therapy before escalation, but if A1C shows any improvement, 6 months is reasonable
  • from Endocrinologist Nation 3 months
    Depends on pt’s symptoms and the degree of hyperglycemia. Ideally I’d like to see pts every 4 weeks and make adjustments based on their BG readings. If pt is on insulin, I frequently see him every 2 weeks for insulin titration
  • 3 months 1 week
    Every three months for non-insulin regimens. If glucose fluctuating per patient or remaining high then will adjust monthly. With insulin will adjust monthly if sugars remaining high per patient reports. Will also have patients self adjust their insulin dose based on glucose checks every 3 days.
  • 3 months 1 week
    I usually for communication fro patient 2 -4 weeks after start of treatment to communicate blood sugar response and any issues regarding adherence, side effects. Assess a1c levels and renal function 3 months after treatment change.
  • 3 months 1 week
    Usually after 3 month . But if initial A1c more than 10 then I will reevaluate the n 1 -2 months
  • 3 months 1 week
    It is useful to follow the A1C, but also markers for microalbumuria, F2 isoprostanes, and an insulin resistence score panel. These show whether effects of diabetes treatment are only part of the issue
  • 3 months 1 week
    If I start a patient on a new medication, I always like to see my patient for a quick visit (usually via Telemedicine), in a couple of weeks to ask if any side effects (GI usually or any other concerns, med approved by Insurance, tolerance, etc) and if patient agreeing with the new medicine, then I will see the patient back in 3 months for reevaluation previous blood tests drawn (HbA1c, BMP, electrolytes), and adjust or continue with the same medicine as needed. I also take advantage of every visit to emphasize on adjuvant diet and daily exercises, since any med by itself has to work harder to achieve glucose control.
    Keys consideration to change meds or to escalate would be, med intolerance, allergy, not approved by Insurance and clinically, if despite appropriate use and accompanying low carb diet and daily exercises, pt's insulin resistance is high and HbA1c still 8.5 or higher. At this point with a HbA1c of 8.5 or higher Insulin will need to be started and patient educated on self administration technique and daily adjusting of Insulin, if basal Insulin is started.
  • 3 months 1 week
    every 3 months like everyone else standard of care
    insulin will recheck in about a month
  • 3 months 1 week
    Like to see again in 90 days after first diagnosis. Then depending upon how the patients A1c is doing will check in 90 to 180 days on regular basis
    WGJ
  • 3 months 1 week
    I will usually reevaluate after a 3 month time period. If a1c still higher than desired, will consider next option. Many times I will ask if patient prefers an injectable vs. non injectable option
  • 3 months 1 week
    Fructosamine level can be helpful if looking to adjust more quickly.
  • 3 months 1 week
    Can be 3 or 6 months depending on compliance and A1c change. Willingness to use injectable and insurance coverage are factors.
  • 3 months 1 week
    first- email communication within first week to see there are no issues with meds prescribed-even if not called Then at next visit in 3 months or so to have rechecked labs and HgA1C and adjust as see fit. Initial regime will depend on labs from first visit and starting HgA1C. Have discussion with patient input into the decision re meds to start and if needed, change















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  • 3 months 1 week
    I would consider treatment modification after 3 months
  • 3 months 1 week
    So, if the a1c is above 7 and patient is already on metformin and sulfonylureas, then consideration for dpp4, glp-1 analogs or sglt-2 inhibitors (the glifzolins). Despite being nee, even certain medicaid plans are making efforts to making atleast one medicine in each class as part of their formulary.
  • from Pharmacist Society 3 months 1 week
    cost for some of these medications can be a big issue as well.
  • from Pharmacist Society 3 months 1 week
    every 3 months. usually side effects are the main cause for switching things up, as they will cause adherence to bottom out. adherence to injectable medications like trulicity can also be a hurdle to overcome. i try to encourage patients to reach out to me if problems arise before the 3 month reevaluation comes.
  • 3 months 1 week
    Generally every 3 mo with a treatment change. If instituting insulin 2-4 weeks
  • 3 months 1 week
    Every 3 months depending on A1C.