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
cmdMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHMLesyle 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,
reyY 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
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Metformin 1ZD
ferry Cry
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If glyceria
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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 hypoglycemiaLGORITHM
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Ea _ =
fecnie ee
Y Metformin LL ETA ee Sia
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