HYPERGLYCEMIA ON ORAL AGENTS

 

TAKE HOME MESSAGES:

1.  Metformin should always be first-line, unless contraindicated

 

2.  Each class of oral agents decreases A1C by 1.0% on average

 

3.  Your choice beyond metformin should be tailored to the patient

 

 

When deciding which oral agents to use, consider:

 

A.  What is the starting A1C?

- with some exceptions, most classes of oral antihyperglycemia agents (OAHA's) are similar in their A1C-lowering efficacy

- a good prediction is each will lower A1C by 1.0%.

- depending on your starting A1C, you may need more than one medication to get A1C to target

 

B.    How many classes of medication do I predict will be needed to get A1C down to target?  

-  for example:


o 
baseline A1C is 7.8%.  Starting one type of OAHA will lower it roughly 1.0%.  Therefore expect A1C to be lowered to ~ 6.8% (i.e. 7.8% - 1.0%)


o baseline A1C is 9.5%.  If starting one type of OAHA, estimate A1C to be lowered to 8.5% only.  Therefore, consider starting more than one medication, or      start insulin.

 

C.  Which class(es) of medications best match my patientís needs and profiles?

-   tailor your choice based on the patientís profile (A1C, comorbidities, weight (or concerns of weight), finances)

 consider also HOW FAST you need treatment to work

 

       TAKE HOME MESSAGES:

1. Metformin should ALWAYS be first FIRST-LINE unless contraindicated

2. What you add after that will depend on the patient's profile (see the information below on the different classes)

 

-   if you need something to work quickly, use INSULIN or an INSULIN SECRETAGOGUE

-   DO NOT USE MORE THAN ONE MEDICATION FROM ONE CLASS OF MEDICATIONS

-   see more information about each class of medication after the Case Examples

 

            Click here for specific case examples.

 

        Click here for background information on the various oral agents, as well as GLP1 analogs.

 

 

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