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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(CLICK FOR MORE)Metformin
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(CLICK FOR MORE)SU
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(CLICK FOR MORE)Insulin
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(CLICK FOR MORE)Acarbose
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(CLICK FOR MORE)DPP-4 inhibitor
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(CLICK FOR MORE)SGLT2 inhibitor
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(CLICK FOR MORE)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
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(CLICK FOR MORE)SGLT2 inhibitor
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(CLICK FOR MORE)SU
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(CLICK FOR MORE)GLP-1RA
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(CLICK FOR MORE)Insulin
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(CLICK FOR MORE)Acarbose
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(CLICK FOR MORE)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
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(CLICK FOR MORE)GLP-1RA
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(CLICK FOR MORE)Insulin
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(CLICK FOR MORE)Acarbose
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(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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(CLICK FOR MORE)If on GLP-1RA
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(CLICK FOR MORE)If on basal insulin
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Note:
PBS = Pharmaceutical Benefits Scheme
SU = sulfonylurea
TZD = thiazolidinedione
DPP-4 = dipeptidyl peptidase-4
GLP-1RA = glucagon like peptide 1 receptor agonist
SGLT2 = sodium glucose transporter.
Order of boxes is not meant to denote any specific preference