The ADA Type 2 Diabetes Management Algorithm

(soothing music) – [Instructor] Many
diabetes care organizations create algorithms for
antihyperglycemic therapy in adults. They are important consultation
tools for physicians creating individualized
patient treatment plans. The algorithm for this course is based on the 2018 American Diabetes Association, ADA, algorithm. After this explanatory module,
you’ll have the opportunity to both download a
printable copy and explore an interactive version of
our treatment algorithm. (key clicking) It is organized by A1C
results and contains four main therapy categories. Monotherapy, dual therapy, triple therapy, and combination injection therapy. Each therapy offers some basic information about standard drug classifications
for diabetes treatment, includes lifestyle
management in tandem with pharmaceutical suggestion, and each tier of the algorithm is
designed to be reevaluated for efficacy every three months. Your patient’s treatment
should be adjusted as needed based on the results of
their regular evaluations. Let’s take closer look at monotherapy. Monotherapy should be
considered for individuals younger than 60 years
old, with pre-diabetes, a BMI greater than 35,
and women with a history of gestational diabetes, GDM. It can also be used
for first line therapy, if the A1C is less than 9%. These therapies highlight
important factors that are different for each agent, such as the general efficacy of the agent, the risk of hypoglycemia,
how likely the agent is to affect the patient’s
weight, or other general side effects or
comorbidities that need to be taken into consideration,
and the cost of treatment. Determining which agents
are best for your patient’s treatment requires weighing
these factors with the patient’s lifestyle and capacity
for additional lifestyle management changes. The next step is dual
therapy, where we see examples of how to balance multiple
agents in treatment. Dual therapy is suggested for
patients with an A1C equal to or greater than 9%, but less than 10%. The treatment includes
lifestyle management strategies, metformin, and an additional agent. Possible secondary agents
include SGLT2 inhibitors, GLP-1 Agonist, DPP-4 inhibitors, TZDs, second generation
sulfonylureas, and insulin. Patient factors play a
critical role in deciding which agents will be best. For example, a TZD would be
contraindicated for a patient who has a history of
congestive heart failure, as these agents have the
potential for increased water retention and weight gain. Therapies should be designed to encourage maximum potential for adherence. Spending time learning about
your patient’s day-to-day routine and lifestyle
patterns is time well spent for the right fit. A patient who expresses an inability to alter a busy lifestyle to
balance frequent medication regimens, in using an agent
with the highest efficacy and least-frequent dosing
requirements, even if it means a higher cost and potential weight gain. It then becomes important to
counsel them on other lifestyle management changes to offset
the risk of weight gain. If the patient’s A1C is not
at target after three months, on mono- and/or dual therapy,
triple therapy could be considered, adding a
second additional agent. When a patient is not showing improvement with previous therapies,
assessing medication adherence before adding another agent is crucial. It is also prudent to
review the patient’s recent medical history to ensure
no other changes in health or medication could be
interfering with the current treatment regimen or represent potential contraindications that were not an issue under previous regimens. Talk to your patient on
how each option will affect and be affected by their own lifestyle and medication adherence. Combination insulin therapy
should be considered when the A1C is equal
to or greater than 10%, blood glucose is greater than or equal to 300 milligrams per
deciliter, or the patient has symptoms of hyperglycemia. It is not uncommon for patients to be wary of introducing an injectable medication and therefore it is important to discuss the pros and cons with your
patients, and be sensitive to the extra support they may
need adjusting to the idea and practice of regular injections. This section of the algorithm
gives you guidelines for how to start, when to
adjust, and how to manage the increased risk of hypoglycemia. This concludes our
overview of the algorithm. You may now advance to
the interactive algorithm, which allows you to
click around each layer of the algorithm to learn
more about the agents, how they work, and what the
current research indicates.

5 Replies to “The ADA Type 2 Diabetes Management Algorithm”

  1. Short, simply explained, straightforward illustrations yet quite detailed and concise – such that a layman or child will still understand. This is how medicine should be taught 😁👍👌🏻

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