Diabetes Mellius type 2 - Oral and Insulin therapy-

Pharmacological Therapy for Type 2 Diabetes

Recommendations

• Metformin is the preferred initial pharmacological agent for type 2 diabetes. A

 Metformin may be safely continued down to glomerular filtration rate (GFR) of 45 mL/min/1.73 m2 or even 30 mL/min/1.73 m2. If metformin is used in the lower GFR range, the dose should be reduced and patients should be advised to stop the medication for nausea, vomiting, and dehydration.

• 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. 

• For patients with type 2 diabetes who are not achieving glycemic goals, insulin therapy should not be delayed. B

Insulin therapy

Basal insulin is usually prescribed in conjunction with metformin and possibly one additional noninsulin agent. 

Resources:
American Diabetes Association. Approaches to glycemic treatment. Sec. 7. In Standards of Medical Care in Diabetes—2016. Diabetes Care 2016;39(Suppl. 1):S52–S59