8
Standards of Medical Care
Type 2 Diabetes
ÎMetformin, if not contraindicated and if tolerated, is the preferred initial
pharmacologic agent for type 2 diabetes. (A)
ÎIn newly diagnosed type 2 diabetes patients with markedly symptomatic
and/or elevated blood glucose (BG) levels or A1c, consider insulin
therapy, with or without additional agents, from the outset. (E)
Î If noninsulin monotherapy at maximal tolerated dose does not achieve
or maintain the A1c target over 3 months, add a second oral agent, a
glucagon-like peptide 1 (GLP-1) receptor agonist, or insulin. (A)
Î A patient-centered approach should be used to guide choice of
pharmacologic agents. Considerations include efficacy, cost, potential
side effects, effects on weight, comorbidities, hypoglycemia risk, and
patient preferences. (E)
Î Due to the progressive nature of type 2 diabetes, insulin therapy is
eventually indicated for many patients with type 2 diabetes. (B)
Diabetes Self-Management Education (DSME)
ÎPeople with diabetes should receive DSME and diabetes self-
management support (DSMS) according to National Standards for
Diabetes Self-Management Education and Support when their diabetes is
diagnosed and as needed thereafter. (B)
Î Effective self-management and quality of life are the key outcomes of
DSME and DSMS and should be measured and monitored as part of
care. (C)
Î DSME and DSMS should address psychosocial issues, since emotional
well-being is associated with positive diabetes outcomes. (C)
Î DSME and DSMS programs are appropriate venues for people with
prediabetes to receive education and support to develop and maintain
behaviors that can prevent or delay the onset of diabetes. (C)
Î Because DSME and DSMS can result in cost savings and improved
outcomes (B), DSME and DSMS should be adequately reimbursed by
third-party payors. (E)
Medical Nutrition Therapy (MNT)
Î Nutrition therapy is recommended for all people with type 1 and type
2 diabetes as an effective component of the overall treatment plan. (A)
Î Individuals who have prediabetes or diabetes should receive
individualized MNT as needed to achieve treatment goals, preferably
provided by a registered dietitian familiar with the components of
diabetes MNT. (A)
