Glycemic Control Algorithm 2 (Text Description)
The Glycemic Control Algorithm for DM2 begins with a text box that reads:
| Assess
A1c result
Note:
A1c result should be no older than 3 months |
Two arrows lead from it. The one to the left is labeled "A1c <7.0" and points to a box that reads:
The one to the right is labeled "A1c >7.0" and points to a box that reads:
Planned Visit—complete assessment of glycemic control program (see Module 4 Podcast)
—Advise relevant lifestyle changes
Is patient amenable to additional oral agents therapy? See Oral Agent Classes and medication based on current efficacies of meds and a conservative estimate of potential for lifestyle change (See Module 1 Podcast)
|
Two arrows lead from this box to three boxes below it. The box to the left reads:
Currently on Secreatagogue
(Sulfonylureas or Medlinitide)
1st option—Titrate to maximal effective dose
of secreatagogue ( A1c < 8.0)
Recheck A1c in 3 months
2nd option—Add sensitizer (TZD or Metformin)
unless contraindicated—work up to maximal dose as the clinical situation
warrants
Recheck A1c in 3 months
3rd option—Add other sensitizer unless
contraindicated work up to maximal dose as clinical situation warrants (for
example start with 500 mg Metformin up to 2000mg daily dose) with quarterly
reassessments.
4th option—consider alpha-glucosidase
inhibitors vs insulin
Recheck A1c in 3 months
|
The box in the center reads:
Already on Sensitizer
1st option—Titrate to maximal effective dose of A1c <8.0
Recheck A1c in 3 months
2nd option—Add secreatogogue (Meglinitide, Sulflonylureas)
Recheck A1c in 3 months
3rd option—Add additional sensitizer unless contraindicated
Recheck A1c in 3 months
4th option—consider alpha-glucosidase inhibitors vs insulin
Recheck A1c in 3 months
|
The box to the right reads:
Not amenable to addition of further oral agents
If patient is here—call Dr. Salem or contact Faculty for insulin order at that visit
Return visit or recontact in 1 week
|
There are two reference tables:
Table 1
| Oral Agent Classes/MEDS |
Potential % decline A1c |
| Solo | Combined |
| Sulfonlureas |
2% |
1% |
| Metformin |
2% |
1% |
| Meglinitides |
|
|
| Prendin |
2% |
1% |
| Starlix |
1% |
.5% |
| TZDs |
2% |
1% |
| Alpha Glucosidase Inhibitors |
1% |
.5% |
Table 2: Maximum Effective Doses
| Medication | Maximum Effective Dose |
| Amaryl |
4 mg daily |
| Gulcotrol |
10 mg daily |
| Diabeta |
10 mg daily |
| Prandin |
4 mg tid |
| Starlix |
120 mg tid |
| Actos |
45 mg daily |
| Avandia |
8 mg daily |
| Precose |
150 mg tid |
| Glyset |
150 mg tid |
| Metformin |
2000 mg total daily |
The following notes are at the bottom of the algorithm:
Notes:
- If option is available—have patient call in the nurse line with home blood sugar logs weekly to make adjustments more rapidly. When at goal, recheck A1c in 3 months.
- Any patient who has additional OA prescribe should be seen/contact within 2 week to insure adherence/tolerability of meds and to access the current HGM results and status. Option to increase oral agent dose(s) that that point.
- Review of HGM status include w/each reassessment, tailored recommendations for frequency of HGM given with each med change.
- Team meeting optional at any point for lack progress—as determined by nurse practitioner.
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