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Comparing Medications for Adults With Type 2 Diabetes

Slide: 13 of 35

Conceptual Model

This conceptual model describes the decisions that patients and their providers face when managing type 2 diabetes pharmacologically. It highlights the comparisons and outcomes of interest covered in the updated review. When beginning medical treatment, patients usually begin with one of six drug classes, which have all been FDA-approved for monotherapy. These include biguanides, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, meglitinides, and the GLP-1 receptor agonists. Clinical guidelines of the American Diabetes Association recommend monitoring the HbA1c to determine the need for changing the medication dose or adding another agent to improve glycemic control. If the HbA1c is not adequately controlled, clinicians typically add an additional medication, or may add insulin or a noninsulin injectable medication like a GLP-1 agonist. Both intermediate- and long-term outcomes are monitored as indicators of effectiveness. Intermediate outcomes include HbA1c, weight, and lipids. In addition, clinicians monitor short-term and long-term safety and adverse effects of the drug.