Sanaz Sakiani, MD
Endocrinology Fellow
Journal Club 2-16-12
2012 ADA CLINICAL PRACTICE GUIDELINES
THERAPIES FOR DM- TYPE 2
THERAPIES FOR DM2 - RECOMMENDATIONS
 At
the time of DM2 diagnosis, initiate
metformin therapy along with lifestyle
interventions (MNT and exercise), unless
metformin is contraindicated.
THERAPIES FOR DM2 - RECOMMENDATIONS
 In
newly diagnosed type 2 diabetic patients
with markedly symptomatic and/or elevated
blood glucose levels or A1C, consider insulin
therapy, with or without additional agents, from
the outset.
THERAPIES FOR DM2 - RECOMMENDATIONS
 If
noninsulin monotherapy at maximal tolerated
dose does not achieve or maintain the A1C target
over 3-6 months, add a second oral agent, a GLP1 receptor agonist, or insulin.
 If
A1C targets are not achieved, treatment
intensification is based on the addition of another
agent from a different class
 Meta-analyses suggest that overall, each new class of
non-insulin agents added to initial therapy lowers the
A1C by around 0.9-1.1%
THERAPIES FOR DM2 - RECOMMENDATIONS
 ADA
and EASD have partnered on new
guidance for individualization of use of
medication classes and combinations in
patients with DM2.
 These
guidelines will be published in early 2012