Type 2 Treatment Algorithm
Creatinine > =1.4 (Renally impaired) Rx insulin OR thiazolidinediones OR diet AND avoid biguanides or SASKA's
Creatinine < 1.4 (Intact renal function)
BMI >=30 (Obese) BEGIN metformin therapy
A1c <8% CONTINUE metformin if tolerated at <= 2g/day
A1c >=8% AND LDL-cholesterol >=100 AND NOT using p-450 3A3,4,5 agents ADD pioglitazone
A1c < 8% CONTINUE pioglitazone if tolerated at <= 45mg/day
A1c >=8% D/C pioglitazone ADD insulin
A1c >=8% AND LDL-cholesterol < 100 OR using p-450 3A3,4,5 agents ADD rosiglitazone
A1c < 8% CONTINUE rosiglitazone if tolerated at <=8 mg/day
A1c >=8% D/C rosiglitazone ADD insulin
A1c >=8% AND metformin NOT tolerated ADD insulin OR follow ¶2.2.2 and below
BMI < 30 BEGIN with Diet Therapy
A1c <8% then CONTINUE diet
A1c >=8% AND LDL-cholesterol >=100 AND NOT using p-450 3A3,4,5 agents ADD pioglitazone
A1c < 8% CONTINUE pioglitazone if tolerated at <= 45 mg/day
A1c >=8% ADD insulin
A1c >=8% AND LDL-cholesterol < 100 OR using p-450 3A3,4,5 agents ADD rosiglitazone
A1c < 8% CONTINUE rosiglitazone if tolerated at <= 8mg/day
A1c >=8% D/C rosiglitazone and ADD insulin
A1c >=8% AND thiazolidinediones NOT tolerated SWITCH to LOW-doses of "SASKA" (selective ATP-sensitive K-channel antagonist) like glimepiride (<=2mg/day) or repaglinide (<=1.5 mg/day.) If A1C stays >8% after 3-6 months SWITCH to insulin
Home->Type 2 Area Menu->Type 2 Rx Algorithm
The NDC
considers the following Rx
algorithm published by the ACP as harmful
and misguided due to its
recommendation of (1) KATP- channel antagonists which
cause coronary vasoconstriction (sulfonylureas)
as first line therapy (2) A1c action points of
>7% which in
the absence of any corroberating data appear
overly tight and may lead to excessive
hypoglycemia, morbidity, and mortality and (3)
triple therapy which has neither
been sanctioned by FDA nor has any long-term
safety data to recommend it:- |
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