Practical and Financial Considerations

The authors advise practitioners to “consider the significant expense and additional complexity and costs of multiple combinations of glucose-lowering medications” and caution avoidance of “overly burdensome regimens.” They note that the inability to achieve glycemic target with an “increasingly convoluted regimen should prompt a pragmatic reassessment of the HbA1c target or, in the very obese, consideration of nonpharmacologic interventions, such as bariatric surgery.”2

They emphasize the importance of nutritional counseling, diabetes self-education, and cognizance of frequently-encountered comorbidities, such as coronary artery disease, heart failure, renal and liver disease, dementia, and the likelihood of hypoglycemia. The authors highlight the importance of taking cost into account when designing a regimen. They suggest that generic drugs might be substituted when possible, and that combination products may reduce pill burden. They also note that the recommendations will likely be updated again in the coming years, as new data emerge.


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