Diabetes Care Algorithms Overview

Aug 24, 2024

Diabetes Care Algorithms for Antihyperglycemic Therapy

Introduction

  • Diabetes care organizations develop algorithms for antihyperglycemic therapy to aid physicians.
  • Based on the 2018 American Diabetes Association (ADA) algorithm.
  • Provides tools for creating individualized patient treatment plans.
  • Available in printable and interactive formats.

Algorithm Organization

  • Organized by A1C results.
  • Four main therapy categories:
    • Monotherapy
    • Dual Therapy
    • Triple Therapy
    • Combination Injection Therapy

Key Features

  • Basic information on drug classifications.
  • Includes lifestyle management alongside pharmaceutical suggestions.
  • Reevaluation every three months based on efficacy.
  • Treatment adjustments based on patient evaluations.

Monotherapy

  • Suitable for:
    • Individuals under 60 years.
    • Pre-diabetes patients.
    • BMI > 35.
    • History of Gestational Diabetes Mellitus (GDM).
    • First line therapy if A1C < 9%.
  • Considerations:
    • General efficacy.
    • Risk of hypoglycemia.
    • Impact on weight and side effects.
    • Treatment cost.
    • Lifestyle and capacity for lifestyle changes.

Dual Therapy

  • Recommended for A1C ≥ 9% but < 10%.
  • Involves:
    • Lifestyle management.
    • Metformin plus an additional agent.
  • Possible secondary agents:
    • SGLT2 Inhibitors
    • GLP-1 Agonists
    • DPP-4 Inhibitors
    • TZDs
    • Second generation Sulfonylureas
    • Insulin
  • Patient factors critical for agent selection.
  • Encourage adherence by understanding patient lifestyle.

Triple Therapy

  • Consider when A1C not at target after 3 months of mono- or dual therapy.
  • Add a second additional agent.
  • Assess medication adherence and review recent medical history.
  • Understand patient lifestyle and adherence.

Combination Injection Therapy

  • Consider when:
    • A1C ≥ 10%.
    • Blood glucose ≥ 300 mg/dL.
    • Symptoms of hyperglycemia.
  • Address patient concerns about injectables.
  • Discuss pros/cons and offer support for adjustment.
  • Guidelines for initiation, adjustment, and managing hypoglycemia risk.

Conclusion

  • Explore the interactive algorithm for more detailed insights on agents and current research.