T2DM

Type 2 Diabetes Mellitus

ADA (American Diabetes Association) Guidelines:

Step 1

at diagnosis, advice change in lifestyle + metformin

Step 2

either:

Lifestyle + metformin +basal insulin OR

Lifestyle + metformin+ sulphonylurea

Step 3

Lifestyle + metformin + intensive insulin or bolus insulin

frm Harrisons Manual of Medicine:

A reasonable algorithm for initial therapy proposes Metformin as initial therapy. Why?

*its efficacy-- 1-2% decrease in HbA1c

*known side effect profile

*relatively low cost

*promotes weight loss

*lowers insulin levels (?increased insulin action on muscle and fat)

*improves lipid profile slightly

*does NOT cause hypoglycaemia when used as monotherapy

therefore it is the drug of choice in T2DM

Metformin is c/i in:

- renal insufficiency

- congestive heart failure

- any form of acidosis

- liver disease

- severe hypoxia

*should be temporarily discontinued in pts who are seriously ill or receiving radiographic contrast material