Table 5 – Individualizing A1C Targets

Target Which Patients
6.0% to 6.5% • No clinically significant CVD
• Recent onset of T2D
• If achieved without substantial hypoglycemia or other adverse effects
7.0% to 8.0% • History of severe hypoglycemia
• Limited life expectancy
• Advanced renal disease
• Microvascular complications
• Extensive comorbid conditions
• Long-standing T2D in which A1C goal has been difficult to obtain despite intensive efforts
• Patient must remain free of polydipsia, polyuria, polyphagia, or other hyperglycemia-associated symptoms

CVD=cardiovascular disease; T2D=type 2 diabetes
Garber AJ, et al. Endocr Pract. 2017 Jan 17. [Epub ahead of print]


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Table 6 – Pharmacotherapy for Glycemic Control
(Order of medications represents suggested hierarchy of usage)

Entry A1C <7.5% Entry A1C ≥7.5% Entry A1C ≥7.5% Entry A1C >9.0%
Monotherapy
• Metformin
• GLP1-RA
• SGLT-2i
• DPP-4i
• TZD*
• AGi
• SU/GLN*
Proceed to dual therapy if not at goal in 3 months
Dual Therapy
Metformin or other 1st-line agent, plus—
• GLP-1RA
• SGLT-2i
• DPP-4i
• TZD*
• Basal insulin*
• Colesevelam
• Bromocriptine QR
• AGi
• SU/GLN*
Proceed to triple therapy if not at goal in 3 months
Triple Therapy
Metformin or other 1st-line agent, + 2nd-line agent, plus—
• GLP-1 RA
• SGLT-2i
• TZD*
• Basal insulin*
• DPP-4i
• Colesevelam
• Bromocriptine QR
• AGi
• SU/GLN*
Proceed to or intensify insulin therapy if not at goal in 3 months
Asymptomatic:
• Dual therapy or
• Triple therapy

Symptomatic
• Insulin ±
• Other agents

Add to/intensify insulin

*Use with caution
GLP-1 RA =glucagon-like peptide-1 (GLP-1) receptor agonists; SGLT2=sodium glucose cotransporter 2 inhibitors; DPP-4i=dipeptidyl peptidase 4 inhibitors; TZD= thiazolidinediones; AGi=alpha-glucosidase inhibitors; SU= sulfonylureas

Table 7 – Factors To Take Into Account when Choosing Antihypertensive Therapy

• Presence of albuminuria
• CVD
• Heart failure
• Post myocardial infarction status
• Race/ethnicity
• Possible metabolic side effects
• Pill burden
• Medication cost

ASCVD=atherosclerotic cardiovascular disease; LDL-C = low-density lipoprotein cholesterol;
HDL-C = high-density lipoprotein cholesterol; apo B = apolipoprotein B
Garber AJ, et al. Endocr Pract. 2017 Jan 17. [Epub ahead of print]

Table 8 – Risk Categories and Lipid Targets for Patients with T2D and Dyslipidemia

Risk Category Risk Factors Targets
High • Diabetes with no other risk factors • LDL-C <100 mg/dL
• Non-HDL-C <130 mg/dL
• apo B <90 mg/dL
Very high • Diabetes + 1 additional risk factor (insulin resistance, characterized by hypertension, hypertriglyceridemia, low HDL-C, elevated apoB, small dense LDL-C and procoagulant/proinflammatory milieu) • LDL-C <70 mg/dL
• Non-HDL-C <100 mg/dL
• apoB <80 mg/dL
Extremely high • Prior ASCVD event
• Recognized clinical ASCVD
• Chronic kidney disease stage 3 or 4
• LDL-C <55 mg/dL
• Non-HDL-C <80 mg/dL
• apo B <70 mg/dL

ASCVD=atherosclerotic cardiovascular disease; LDL-C = low-density lipoprotein cholesterol; HDL-C = high-density lipoprotein cholesterol; apo B = apolipoprotein B
Garber AJ, et al. Endocr Pract. 2017 Jan 17. [Epub ahead of print]