Australian Blood Glucose Treatment Algorithm for type 2 diabetes

Lifestyle measures

diet, exercise and weight control should be the initial approach and reinforced at each stage.

All patients should receive education regarding lifestyle measures: healthy diet, physical activity and weight control.

If not at target, or if a Hb1Ac reduction of ≥ 0.5% is not achieved after 3 months

move down the algorithm.

Press or click the lines to reveal the plan.

1st line

Metformin is the usual 1st line therapy unless contraindicated or not tolerated.

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If Hb1Ac target not achieved in 3 months

  • Check and review current therapies, stop any that fail to improve glycaemic control
  • Check patient understanding and self management
  • Review adherence with therapies
  • Exclude other comorbidities/therapies impacting on glycaemic control
  • Reinforce lifestyle measures
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    Metformin
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    SU
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    Insulin
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    Acarbose
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    DPP-4 inhibitor
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    SGLT2 inhibitor
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    TZD
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2nd line

If Metformin was not used in the first line, add it now if not contraindicated.

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Choice of second line agent to add to metformin should be guided by clinical factors/considerations, contraindications, side effect profile and cost.

 

If Hb1Ac target not achieved in 3 months

  • Check and review current therapies, stop any that fail to improve glycaemic control
  • Check patient understanding and self management
  • Review adherence with therapies
  • Exclude other comorbidities/therapies impacting on glycaemic control
  • Reinforce lifestyle measures
  • (CLICK FOR MORE)
    DPP-4 inhibitor
  • (CLICK FOR MORE)
    SGLT2 inhibitor
  • (CLICK FOR MORE)
    SU
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    GLP-1RA
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    Insulin
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    Acarbose
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    TZD
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3rd Line

Consider triple oral therapy or addition of GLP-1RA or insulin.

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If Hb1Ac target not achieved in 3 months

  • Check and review current therapies, stop any that fail to improve glycaemic control
  • Check patient understanding and self management
  • Review adherence with therapies
  • Exclude other comorbidities/therapies impacting on glycaemic control
  • Reinforce lifestyle measures
  • (CLICK FOR MORE)
    DPP-4 inhibitor
  • (CLICK FOR MORE)
    SGLT2 inhibitor
  • (CLICK FOR MORE)
    SU
  • (CLICK FOR MORE)
    GLP-1RA
  • (CLICK FOR MORE)
    Insulin
  • (CLICK FOR MORE)
    Acarbose
  • (CLICK FOR MORE)
    TZD
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4th Line

Next Steps

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If Hb1Ac target not achieved in 3 months

  • Check and review current therapies, stop any that fail to improve glycaemic control
  • Check patient understanding and self management
  • Review adherence with therapies
  • Exclude other comorbidities/therapies impacting on glycaemic control
  • Reinforce lifestyle measures
  • (CLICK FOR MORE)
    If on triple oral therapy
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    If on GLP-1RA
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    If on basal insulin
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