Consultant Physician

AACE/ACE* Diabetes Algorithm For Glycemic Control 2009 : A1C Goal ≤ 6.5%**
Monotherapy
MET TZD DPP-4 AGI
+
2-3 MOs
Dual Therapy
GLP-1 or DPP-4
TZD
Glinides or SU
MET + GLP-1 or DPP-4
MET +
Lifestyle modification
“Stratified by A1Cs and documented evidence of of efficacy”
A1C 6.5 – 7.5% A1C 7.6 - 9.0% A1C > 9.0%
+
MET +
GLP-1 or
DPP-4
Colesevelam
AGI
2-3 MOs
Triple Therapy
+ A1C:
6.5% to
7.5%
Insulin
and other
agent (s)
TZD
Glinides or SU
2-3 MOs
3 broad ranges =3 pathways
MET +
Dual Therapy
GLP-1
or DPP-4
or TZD
SU or Glinides
Triple Therapy
GLP-1
or DPP-4
GLP-1
or DPP-4
A1C: TZD
7.6% to
9.0%,
Insulin
and other
agent (s)
2-3 MOs
+
TZD
+ SU
2-3 MOs
Drug Naive
Symptoms
Insulin
and other
agent (s)
No symptoms
MET +
GLP-1
or DPP-4
A1C:
>9.0%
TZD
GLP-1
or DPP-4
TZD:Thiazolidinediones
Met: metformin
AGI: alpha glucosidase inhibitors
SU: sulfonylurea
Under treatment
±
SU
±
TZD
Insulin
and other
agent (s)
* American Association of Clinical Endocrinologists/American
College of Endocrinology (AACE/ACE)
** Rodbard,H. Am J Manag Care. 2010;16:S187-S194