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
Metformin +
Sulfonylureab high
moderate risk gain
hypoglycemiac low
Metformin +
Thiazolidine- dione
high low risk gain
edema, HF, Fx'sc high
Three-drug combinations
Metformin +
Sulfonylureab +
TZD
or or or
DPP-4-i GLP-1-RA Insulind
or or or
Metformin +
Thiazolidine- dione
+ SUb
DPP-4-i GLP-1-RA Insulind
More complex insulin strategies
(multiple daily doses) Insuline
Adapted with permission from: Inzucchi SE, et al. Diabetes Care. 2012 Jun;35(6):1364-1379. a
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."
b Consider beginning at this stage in patients with very high HbA1c (eg, ≥ 9%). 4
