eee) eC ad Lawrence Blonde, MD, FACP, MACE eA ee ned ere) Samuel Dagogo-fack, MD. FACE eae AACE/ACE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM ——— | lll Le TASK FORCE Ucar eRe Daniel Einhorn, MD, FACP, FACE amd ead SL aa red Ce et ea ees Se a eta Pee) Ce aed ceed Jeffrey Mechanick, MD, FACP, FACE, FACN, ECNU Pree need cmdMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHMLesyle therapy, including medically supervised weight os, key to managing type 2 dabetes. Wilght loss should be considered as a ielong goal nal patients with predlabetes and T20 who aso have overweight or best, tlizing behavioral interventions and weight loss medeations a required to achieve chronic therapeutic goat ‘The AIC target ust be individualized Glycemic contrat targetsinciud fasting and postpranal glucoes ‘The choice of therapies must be individualized on bai of patient characteristics, impact of net cost te patient, formulary restntions, personal preferences, tc Minimizing risk of hypoalycemials a pony Minimizing rik of weight gains 2 riety Intl acquisition cost of medications i only part ofthe total cost of cae which includes monitoring eaurements, tak of rypogiyema, weight gain, safety ee This algo stratifies cole of therapies based on nal ATC Combination therapy is usualy required and should involve agents with complementary ations Comprehensive management includes ipl and blood presure therapies and related comerbicite, ‘Therapy mustbe evaluated frequently untl stable eg, every 3 months) and then les often. The therapeutic regimen should be as simple as possible to optimize adherence. ‘This algrthm includes every FOR approved das of medications for dabetes.Cr penny Cee ed Sor) Cessation Maintain optimal weight Calorie restriction (if MI Isincreased) Plant-based die; high polyunsaturated and Monounsaturated fatty acids 150 min/week moderate exertion (eg. walking stair climbing) Strength training Increase as tolerated About 7 hours per night Basic sleep hygiene Community engagement Alcohol moderation No tobacco products ‘Avoid trans fatty acids limit saturated fatty acids Structured program Wearable technologies Screen OSA Home sleep study Discuss mood with He Nicotine replace ment therapy, structured counseling Meal eplacement Medical evaluation? clearance Medica supervision Referral to sleep lab Formal behavioral therapy Referral to structured program| ae. EVALUATION FOR COMPLICATIONS AND STAGING COaeaen BMI = 25 BMI = 25, Cig _ = = t t t ‘Therapeutic targets for Treatment Treatment intensity based Bice Improvement in complications modality on staging — _ Pees ees Peet 35): If therapeutic targets for complications not met, intensify lifestyle, medical, and/or surgical treatment modalities for greater weight loss. Obesity isa chronic progressive disease and requires commitment to long-term therapy and follow-up, reyY FG (100-125) | 1GT (140-199) | METABOLIC SYNDROME (NCEP 2001) 7 iss SO Cel eon eae ete) aa) WEIGHT LOSS Raa ance azar THERAPIES FPG > 100 | 2-hour PG > 140 ASCVD RISK FACTOR ern 1 PRE-OM. MULTIPLE PRE-DM MODIFICATIONS ALGORITHM iran CRITERION CRITERIA DYSLIPIDEMIA HYPERTENSION ma eee ROUTE ROUTE, re i Progression ery POS Terny rn aris fies ar yr Pires) Metformin 1ZD ferry Cry — ~ If glyceria not normalized rr Falreonefbupropion rage 3 me Piaatanesiry exit my an nea eT)STATIN THERAPY eae nee Ee ‘ry alternate statin, ower statin Repeatipid pane Intensy therapies to dose or frequency of add nonstatin assesacequacy, stain goals seording LOL lowering therapies tolerance of therapy Torisklevel peat LOLCat 100 70 < Non HOU maya) 0 0 eS p08 nai) = 6.5% For patients without For patients with concurrent serious concurrent serious illness and at low illness and at risk hypoglycemic risk for hypoglycemiaLGORITHM aS AS re luding Medically Assisted Weight Li Ea _ = fecnie ee Y Metformin LL ETA ee Sia vy GLPALRA + 4% aie Ae = orother fy T2D. ¥ Bromocriptine QR ot colaseel em Saetediame| cts v AGL INSULIN ffeil Algorithm Ly suai ia ace =Ay TDD 0.1-0.2 U/kg JM TDD 0.2-0.3 U/kg eee ree Ss oie £3 rr} Add Prandial Insulin Cary Ec] Cr See ites Becin prandial Begin randil largest meal each meal If notat goal 50% Basal progres to 50% Prandial Injections before 1000305 Ug Zor imeals enn eee ee See eePROFILES OF ANTIDIABETIC MEDICATIONS 7% COLSVL BCR-QR INSULIN. PRAML cr) er Newrat | Neue! | News Per ee nd oe Welch stighttass| Los Loss fe od Gain | Newwat | newiat | Gai Loss [ co , [ pore roe cee] Peer re RENAL/GU ee ee Oe eC ee ecvein Ue cern ossble | possible Benetor | Nbumunura ried ica roy roa} re rey Poa - ae ee Feri ice ik | Nowa! | Newt | Ri ARDIAC: cor Por es co oy etal oid ree} > Cv bene pay Bee BONE Pe srt Pere) Neural | Newral | newtal | Neural | Newtat xeroaciooss aa or ce ko)