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Unformatted text preview: More. . . Copyright © 2006 by Therapeutic Research Center Pharmacist’s Letter / Prescriber’s Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.pharmacistsletter.com ~ www.prescribersletter.com Detail-Document #221103 − This Detail-Document accompanies the related article published in − PHARMACIST’S LETTER / PRESCRIBER’S LETTER November 2006 ~ Volume 22 ~ Number 221103 American Diabetes Association Treatment Algorithm for Type 2 Diabetes Diagnosis of type 2 diabetes Counsel patients regarding lifestyle modification (weight loss, exercise) (expected decrease in HbA1c 1-2%) and initiate metformin [ Glucophage , others] 500 mg once or twice daily, titrate to 850 mg to 1000 mg twice daily (expected decrease in HbA1c 1.5%) HbA1c 7% or greater three months later Add rosiglitazone [ Avandia ] or pioglitazone [ Actos ] (expected decrease in HbA1c 0.5-1.4%) or sulfonylurea (expected decrease in HbA1c 1.5%) or basal insulin (bedtime intermediate-acting insulin or bedtime or morning long-acting insulin) (expected decrease in HbA1c 1.5-2.5%) HbA1c 7% or greater three months later Add additional agent (glitazone or sulfonylurea or insulin) or intensify insulin for those on insulin* HbA1c 7% or greater three months later In patients not yet receiving insulin, add basal insulin or intensify insulin in those already receiving insulin* HbA1c 7% or greater three months later Metformin + intensive insulin with/without glitazone *When prandial rapid or very-rapid acting insulin is added, insulin secretagogues such as the sulfonylureas or the glinides (repaglinide, nateglinide) should be discontinued. • Consider insulin as initial therapy (with lifestyle modification) in patients with fasting glucose greater than 250 mg/dL or HbA1c greater than 10% or those with ketonuria or symptoms of hyperglycemia. • When initiating insulin, start with a bedtime dose of an intermediate-acting insulin or once-daily long-acting insulin. Initiate with 10 units or 0.2 units per kg. Check fasting glucose concentrations and increase by approximately 2 units (4 units if fasting glucoses are greater than 180 mg/dL) every 3 days, until fasting glucoses are less than 130 mg/dL. If HbA1c continues to be 7% or greater after 2 to 3 months, with well-controlled fasting glucose concentrations, consider checking pre-meal glucose concentrations. • The algorithm does not include pramlintide [ Symlin ], exenatide [ Byetta ], alpha-glucosidase inhibitors [ Precose, Glyset ], glinides [ Prandin, Starlix ], or sitagliptin [ Januvia ] due to generally lower overall affect on HbA1c, limited information, and/or cost. However, these agents may be appropriate for certain patients. ( Detail-Document #221103: Page 2 of 4) More. . ....
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This note was uploaded on 02/18/2012 for the course PAS 600 - 601 taught by Professor Garrubba during the Fall '10 term at Chatham University.
- Fall '10