CME credit available from Harvard Medical School through April 2019
The primary goal of this educational program is to update primary care physicians on the prevention and management of type 2 diabetes. We present the risks and benefits of the different treatment options and provide guidance on selecting the most appropriate agent for each patient.
Over 29 million Americans have diabetes.1 By 2050, it is expected that 1 in 3 with have diabetes.2Even more people are at risk for developing diabetes with 86 million people with prediabetes (HbA1c of 5.7-6.4%).1 Steps can be taken to slow the progression to diabetes including diet and exercise or metformin.
Once patients are diagnosed with diabetes (HbA1c ≥6.5%), select a target HbA1c. For most patients the HbA1c goal is ≤7%. However a tighter target, such as ≤6.5%, may be appropriate for younger patients and newly diagnosed patients without existing cardiovascular disease. For patients with multiple comorbidities, frail elderly, those at greatest risk of hypoglycemia or with a limited life expectancy, a less stringent HbA1c ≤8% may be reasonable.
All patients start treatment with modification of diet and increased exercise. Many patients will also start on metformin at diagnosis.
Current guidelines recommend metformin for most patients when starting hypoglycemic agents.7 However additional patient factors determine which other agents are selected either at diagnosis or once HbA1c goals are no longer being achieved on monotherapy.
These recommendations are based on current evidence about medication efficacy in relation to clinical outcomes and not only HbA1c levels, as well as data on drug side effects. Further details are provided in the evidence document.
The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating physician based on the individual patient’s clinical condition.