Endocrinologists’ Algorithm for Initiation of Therapy, Based on A1c Levels


Treatment
  • 6.5-7.5%: Monotherapy (usually metformin)
     
  • 7.6-9.0%: Dual therapy: Metformin plus
    – Sulfonylurea or
    – TZD: Pioglitazone or
    – Glinide: Repaglinide/nateglinide or
    – DPP4: Sitagliptin/saxagliptin/linagliptin or
    – GLP-1 agonist: Exenatide/pramlintide/liraglutide
     
  • > 9.0%: Insulin or triple therapy:
    – Metformin
    plus
    – DPP4 (JANUVIA, TRADJENTA, ONGLYZA ) or GLP-1 (BYETTA, VICTOZA)
    plus/or
    – Sulfonylurea (Glipizide) or glinide plus/or TZD
     
  • Metformin + exenatide + pioglitazone at onset ↓ treatment failure by 84% at 2 years