Type 2 Diabetes

CME credit available from Harvard Medical School through April 2019

Published materials

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.

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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.

Diet and exercise are the most powerful ways of preventing diabetes in older adults.3

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.

All patients should initiate lifestyle changes upon diagnosis. 4-6

Treating patients with type 2 diabetes

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.

Algorithm for hypoglycemic therapy in patients with diabetes

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.

Additional Resources for Patients

Information current at time of publication, April 2016.

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.

  1. Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States. 2014.
  2. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality and prediabetes prevalence. Population Health Metrics. 2010(8):29.
  3. Crandall J, Schade D, Ma Y, et al. The influence of age on the effects of lifestyle modification and metformin in prevention of diabetes. J Gerontol A Biol Sci Med Sci. 2006;61(10):1075-1081.
  4. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837-853.
  5. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):854-865.
  6. Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. Jama.2010;304(20):2253-2262.
  7. American Diabetes Association. American Diabetes Association. Standards of medical care in diabetes. Diabetes care. 2016;39 (Suppl 1).