<aside> ⚖️ General management of T2DM:

• HbA1c <7.5% → 3-6 month trial of lifestyle modification

• step 1: HbA1c 7.5-8% → metformin at diagnosis + lifestyle modification

• step 2: metformin monotherapy failure

  • for patients close to HbA1c target (<8.5%), add sulfonylurea (or other diabetic drug depending on comorbidities)
    • stop sulfonylurea if the patient experiences hypoglycemic episodes

  <aside> ⭐ Special considerations (imp)

  • diabetic + ischemic heart disease → GLP-1 agonists (liraglutide, semaglutide) “ozempic/victosa”

  • diabetic + heart failure or CKD → SGLT2 inhibitor (empagliflozin, canagliflozin, dapagliflozin) </aside>

  • basal insulin is second line for patients with HBA1c >8.5% despite metformin and lifestyle modifications

• step 3: HbA1c >9.5% → intensive insulin is preferred

note that step 2 & 3 is in addition to metformin + lifestyle

</aside>

Insulin ★

Oral Antidiabetic Drugs

GLP-1 Agonists & DPP-4 Inhibitors

SGLT-2 Inhibitors

Thiazolidinediones (TZD)

Counseling patients in treatment failure