Type 2 Diabetes - Screening, Diagnosis and Management Algorithm

Lifestyle  Modifications (Diet and Exercise) -> Start Oral Hypoglycemic (First Line: Metformin) -> Start Second Oral 

 Hypoglycemic -> Start Basal Insulin qhs (D/C Secretagogues after starting insulin) -> Start PostPrandial Insulin

A1c Targets:

 • 7.1 – 8.5 % - Recurrent severe hypoglycemia, Limited life expectancy, Frail elderly ± with dementia 

 • 7.1 – 8.0 % - Functionally dependent 

 • ≤ 7.0 % - Most adults 

 • ≤ 6.5 % - Reduces Risk of Complications 

Risk Factors: 

 • Age >= 40 

 • 1st degree relative with DM2 

 • High risk population (Aboriginal, Asian, South Asian, African, Hispanic) 

 • History IFG, IGT 

 • Presence of complications associated with DM 

 • Presence of vascular risk factors (Dyslipidemia, Hypertension, Overweight, Abdominal obesity) 

 • Gestational Diabetes OR macrosomic infant 

 • Secondary Causes: Endocrinopathies (Cushing Syndrome, PCOS), Pancreatic Disease (CF, pancreatitis), Infections (CMV, Rubella) 

 • Medications (Glucocorticoids, Atypical antipsychotics, HAART)



- Amy Chung, MD, MSc @AmyChung 



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