Treatment
Figure 6. Antihyperglycemic Therapy in T2DM:
General Recommendations
Initial drug
monotherapy
Efficacy (↓HbA1c)
Hypoglycemia
Weight
Side effects
Costs
Two-drug
combinationsa
Efficacy (↓HbA1c)
Hypoglycemia
Weight
Major side effect(s)
Costs
Three-drug
combinations
Metformin
+
Sulfonylureab
Thiazolidinedione
high
moderate risk
gain
hypoglycemiac
low
high
low risk
gain
edema, HF, Fx'sc
high
Metformin
+
Sulfonylureab
Metformin
+
Thiazolidinedione
+
+
or
or
or
More complex
insulin strategies
Metformin
+
TZD
DPP-4-i
or
SUb
DPP-4-i
GLP-1-RA
or
GLP-1-RA
Insulin
or
Insulind
d
Insuline
(multiple daily doses)
Adapted with permission from: Inzucchi SE, et al. Diabetes Care. 2012 Jun;35(6):1364-1379.
a
Consider beginning at this stage in patients with very high HbA1c (eg, ≥ 9%).
b
Consider rapid-acting, nonsulfonylurea secretagogues (meglitinides) in patients with irregular meal
schedules or who develop late postprandial hypoglycemia on sulfonylureas.
c
See Table 1 for additional potential adverse effects and risks, under "Disadvantages."
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