ORITHM For Glyce mic Contr ol MODIFICATION
f Clinical Endocrinologists/American College of Endocrinology consensus panel 15: 540-559.
A1C > 9.0% Drug Naive Symptoms
INSULIN ± Other Agent(s)6
No Symptoms GLP-1 or DPP41 MET +
TZD2 GLP-1 or DPP41
± SU7 ± TZD2
INSULIN ± Other Agent(s)6
Under Treatment
A1C Goal ≤ 6.5%*
* May not be appropriate for all patients ** For patients with diabetes and A1c < 6.5%, pharmacologic prescription may be considered
*** If A1c goal not achieved safely † Preferred initial agent 1 DPP4 if PPG and FPG or GLP-1 if PPG 2 TZD if metabolic syndrome and/or nonalcoholic fatty liver disease (NAFLD) 3 AGI if PPG 4 Glinide if PPG or SU if FPG 5 Low-dose secretagogue recommended 6 a) Discontinue insulin secretagogue with multidose insulin b) Can use pramlintide with prandial insulin
7 Decrease secretagogue by 50% when added to GLP-1 or DPP4 8 If A1c < 8.5%, combination Rx with agents that cause hypoglycemia should be used with caution 9 If A1c > 8.5%, in patients on Dual Therapy, insulin should be considered
Table of Annotated Abbreviations* Class
AGI
DPP4 Dipeptidyl-peptidase-4 inhibitor Sitagliptin (Januvia), Saxagliptin (Onglyza) GLP-1 Incretin mimetics (glucagonlike peptide-1 agonist)
α-Glucosidase inhibitor
MET Biguanide SU Sulfonylurea
TZD Thiazolidinedione
Acarbose (Precose), Miglitol (Glyset) Exenatide (Byetta)
Metformin (generic, Glucophage XR, Glumetza, Riomet, Fortamet)
Glyburide (DiaBeta, Glynase, Micronase) Glipizide (generic, Glucotrol, Glucotrol XL) Glimepiride (Amaryl)
*The following single-tablet combinations of agents are available: sitagliptin + metformin (Janumet), pioglitazone + metformin (ActoPlus Met), rosiglitazone + metformin (Avandamet), repaglinide + metformin (PrandiMet), glipizide + metformin (Metaglip and generic), and glyburide + metformin (Glucovance and generic).
Rosiglitazone (Avandia), Pioglitazone (Actos) © AACE December 2009 Update. May not be reproduced in any form without express written permission from AACE Generic (Brand)
