Comparing Medications for Adults With Type 2 Diabetes
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.
- Bennett WL, Wilson LM, Bolen S, et al. Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update. Comparative Effectiveness Review No. 27. (Prepared by Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018.) AHRQ Publication No. 11-EHC038-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2011. Available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=644.
- Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009;32(1):193-203.
- Rodbard HW, Jellinger PS, Davidson JA, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract 2009;15(6):540-559.
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