Glipizide and glipizide XL: preferred in class for renal patients given greater hepatic metabolismĬHF, macular edema, LE edema, fractures, bladder cancerĬontraindicated for CrCl <25 ml/min or Scr ≥2 Glimepiride and glyburide: avoid in elderly patients due to risk of prolonged hypoglycemia. Glimepiride: Dose adjust for renal patients, consider alternative if eGFR <15mL/min To avoid any potential DKA, discontinue before scheduled surgery. Not recommended for eGFR <30 mL/min/1.73 m 2Ĭlass-wide: hypotension, risk of volume depletion, diabetic ketoacidosis, urinary tract infection increases LDL, urosepsis, genital mycosis, polyuria, nausea, AKI, risk of Fournier’s gangrene Sodium-glucose cotransporter 2 (SGLT2 Inhibitor) jĬanaglflozin: lower limb amputations, bone fractures, hyperkalemiaĭapagliflozin, Empagliflozin, Ertugliflozin: Adjust for eGFR <45 mL/min/1.73 m 2 Saxagliptin: increased risk of heart failure Increased amylase and lipase, nausea, vomiting, diarrhea, abdominal pain, dyspepsia, flatulence, GERD, cholelithiasisįDA black box warning: risk of thyroid C-cell tumor in rodents.ĭipeptidyl peptidase 4 (DPP4) Inhibitor g, hĬlass-wide: pancreatitis (rare), joint pain (rare) angioedema (rare) Oral incretin mimetic Glucagon-like Peptide 1 Receptor Agonist (GLP1 RA) h Annual eGFR recommended, more often if at risk of developing renal impairment or have existing DKD. GI side effects - GERD, nausea, diarrhea. Starting metformin in patients with an eGFR between 30-45 mL/min/1.73 m 2 is not recommended. Diet, exercise, and pharmacologic interventions should be initiated for: Hypertension, Hyperlipidemia, Cardiovascular risk reduction, Diabetes complications as indicated.Ĭontraindicated with eGFR <30 mL/min/1.73 m 2. Table 9 summarizes Management of risk factors and complications. Treatment of comorbidities and complications. Routine screening and prompt treatment for cardiovascular risk factors (hypertension, hyperlipidemia, tobacco use) and for microvascular disease (retinopathy, nephropathy, neuropathy) are recommended in the time frames below. Screening for comorbidities and complications. Essential components for diabetes treatment include: diabetes self-management education and support, lifestyle interventions, and goal setting ( Table 3) glycemic management ( Tables 4- 7) and pharmacologic management of hypertension ( Table 8) and hyperlipidemia. Alternatively, diabetes is diagnosed by two separate fasting glucose tests ≥126 mg/dL with symptoms, a glucose ≥200 mg/dL confirmed on a separate day by a fasting glucose ≥126 mg/dL or 2-hour postload glucose ≥200 mg/dL during an oral glucose tolerance test (OGTT). An A1c of ≥6.5%, confirmed by second test, is diagnostic of diabetes. It is important to recognize diabetes types due to insulin deficiency as the pathophysiology directs treatment recommendations. An abbreviated differential diagnosis of diabetes is shown in Table 2. Diagnostic criteria are shown in Table 1. Diagnosis is made by (1) an A1c ≥6.5%, (2) a fasting glucose ≥126 mg/dL, (3) a 2h post 75 gm glucose load glucose of ≥200 mg/dL, or (4) a random glucose ≥200 mg/dL with symptoms, confirmed by a repeat or second test. Consider screening every 3 years, beginning at age 45, or annually at any age if BMI ≥25 kg/m 2, history of hypertension, gestational diabetes, or other risk factors.ĭiagnosis. Type 2 diabetes may be delayed or prevented through diet, exercise, and pharmacologic interventions. To reduce morbidity and mortality by improving adherence to important recommendations for preventing, detecting, and managing diabetic complications.
Adults with, or at risk for Type 2 Diabetes
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