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Management of an Adult With Type 2 Diabetes With Antidiabetic Medications: A Case Scenario

Slide: 7 of 26

Management of HbA1c in an Adult With Type 2 Diabetes

When making a reasonable clinical decision regarding the initiation of treatment with an antidiabetic medication, what evidence about the management of Hb1Ac is most accurate?

Discussion of Answers

A. Incorrect. Explanation: While available antidiabetic oral agents may improve glycemic control (lower HbA1c), there is only evidence of moderate to high strength that metformin, pioglitazone, a second-generation sulfonylurea, and repaglinide all similarly reduce HbA1c by 1 absolute percentage point in recently diagnosed adults with type 2 diabetes. Additionally, from the 2007 AHRQ report on oral antidiabetic agents, there is low strength of evidence that nateglinide and alpha-glucosidase inhibitors are less efficacious in reducing HbA1c (~0.5-1% absolute difference) compared with other oral diabetes medications.

B. Correct. Explanation: There is moderate to high strength of evidence that metformin, pioglitazone, a second-generation sulfonylurea, and repaglinide all similarly reduce HbA1c by 1 absolute percentage point in recently diagnosed adults with type 2 diabetes.

C. Incorrect. Explanation: There is low strength of evidence that nateglinide and alpha-glucosidase inhibitors (acarbose) are less efficacious in reducing HbA1c (~0.5-1% absolute difference) compared with other oral diabetes medications. There is moderate strength evidence that metformin lowers HbA1c better than do dipeptidyl peptidase-4 (DPP-4) inhibitors (sitagliptin and saxagliptin).

D. Incorrect. Explanation: Insulin is an effective form of therapy to reduce glucose levels in any form of diabetes; however, an injectable agent with the potential to cause hypoglycemia is not necessary to achieve glycemic control at the outset in a patient with type 2 diabetes.