Approaches to Glycemic Treatment in Diabetes

2016 ADA Guideline Recommendations
Types of Diabetes Mellitus
Main Diabetes Page
Diabetes type I
Diabetes type II
Gestational Diabetes Mellitus
2016 ADA Standard of Medical Care Guideline Recommendations
Strategies for Improving Care
Classification and Diagnosis of Diabetes
Foundations of Care and Comprehensive Medical Evaluation Diabetes Self-Management, Education, and Support Nutritional Therapy
Prevention or Delay of Type II Diabetes
Glycemic Targets
Obesity Management for Treatment of Type II Diabetes
Approaches to Glycemic Treatment
Cardiovascular Disease and Risk Management Hypertension and Blood Pressure Control Lipid Management Antiplatelet Agents Coronary Heart Disease
Microvascular Complications and Foot Care Diabetic Kidney Disease Diabetic Retinopathy Diabetic Neuropathy Diabetic Footcare
Older Adults with Diabetes
Children and Adolescents with Diabetes Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes Microvascular Complications in Children and Adolescents with Diabetes
Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]

2016 ADA Standards of Medical Care in Diabetes Guidelines

PHARMACOLOGICAL THERAPY FOR TYPE 1 DIABETES

"1. Most people with type 1 diabetes should be treated with multiple-dose insulin injections (three to four injections per day of basal and prandial insulin) or continuous subcutaneous insulin infusion. (Level of Evidence: A)"

"2. Consider educating individuals with type 1 diabetes on matching prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity. (Level of Evidence: E)"

"3. Most individuals with type 1 diabetes should use insulin analogs to reduce hypoglycemia risk. '(Level of Evidence: A)"

"4. Individuals who have been successfully using continuous subcutaneous insulin infusion should have continued access after they turn 65 years of age. (Level of Evidence: E)"

PHARMACOLOGICAL THERAPY FOR TYPE 2 DIABETES

"1. Metformin, if not contraindicated and if tolerated, is the preferred initial pharmacological agent for type 2 diabetes. (Level of Evidence: A)"

"2. Consider initiating insulin therapy (with or without additional agents) in patients with newly diagnosed type 2 diabetes and markedly symptomatic and/or elevated blood glucose levels or A1C. '(Level of Evidence: E)"

"3. If noninsulin monotherapy at maximum tolerated dose does not achieve or maintain the A1C target over 3 months, then add a second oral agent, a glucagon-like peptide 1 receptor agonist, or basal insulin. '(Level of Evidence: A)"

"4. A patient-centered approach should be used to guide the choice of pharmacological agents. Con- siderations include efficacy, cost, potential side effects, weight, co- morbidities, hypoglycemia risk, and patient preferences. (Level of Evidence: E)"

"5. For patients with type 2 diabetes who are not achieving glycemic goals, insulin therapy should not be delayed. (Level of Evidence: B)"