Materiały źródłowe

• #1 Hyperglycemia in diabetes – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631

  High blood sugar, also called hyperglycemia, affects people who have diabetes. Several factors can play a role in hyperglycemia in people with diabetes. They include food and physical activity, illness, and medications not related to diabetes. Skipping doses or not taking enough insulin or other medication to lower blood sugar also can lead to hyperglycemia. […] It’s important to treat hyperglycemia. If it’s not treated, hyperglycemia can become severe and cause serious health problems that require emergency care, including a diabetic coma. Hyperglycemia that lasts, even if it’s not severe, can lead to health problems that affect the eyes, kidneys, nerves and heart. […] In people who have diabetes, glucose tends to build up in the bloodstream. This condition is called hyperglycemia. It may reach dangerously high levels if it is not treated properly. Insulin and other drugs are used to lower blood sugar levels.

• #2 Hyperglycemia in diabetes – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631

  Keeping blood sugar in a healthy range can help prevent many diabetes-related complications. Long-term complications of hyperglycemia that isn’t treated include: cardiovascular disease, nerve damage (neuropathy), kidney damage (diabetic nephropathy) or kidney failure, damage to the blood vessels of the retina (diabetic retinopathy) that could lead to blindness, feet problems caused by damaged nerves or poor blood flow that can lead to serious skin infections, ulcerations and, in some severe cases, amputation, bone and joint problems, teeth and gum infections. […] If blood sugar rises very high or if high blood sugar levels are not treated, it can lead to two serious conditions. Diabetic ketoacidosis. This condition develops when you don’t have enough insulin in your body. When this happens, glucose can’t enter your cells for energy. Your blood sugar level rises, and your body begins to break down fat for energy.

• #3 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  Glycemic management—Target glycated hemoglobin (A1C) levels in patients with type 2 diabetes should be tailored to the individual, balancing the anticipated reduction in microvascular complications over time with the immediate risks of hypoglycemia and other adverse effects of therapy. […] A reasonable goal of therapy is an A1C value of ≤7 percent (53.0 mmol/mol) for most patients. […] Improved glycemic management lowers the risk of microvascular complications in patients with type 2 diabetes. […] Cardiovascular risk factor management—In addition to glycemic management, vigorous cardiac risk reduction (smoking cessation; blood pressure control; reduction in serum lipids with a statin; diet, exercise, and weight loss or maintenance; and aspirin for those with established atherosclerotic cardiovascular disease [ASCVD] or after shared decision-making) should be a top priority for all patients with type 2 diabetes.

• #4 Management of persistent hyperglycemia in type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus

  For most patients, we add a second medication when the individualized glycemic treatment goal is not achieved within three months with metformin plus lifestyle intervention. This is consistent with guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus guideline for medical management of hyperglycemia and underscores the importance of avoiding delay in treatment intensification. […] In some patients, early combination therapy is warranted for the kidney or heart protective benefit imparted by selected classes of glucose-lowering medications. […] Glycemic goals — Target A1C goals in patients with type 2 diabetes should be tailored to the individual, balancing the prospect of reduced microvascular complications with the adverse effects and cost of added treatments. Most younger patients (eg, aged <65 years) without established complications should have an A1C goal of <7 percent (53 mmol/mol) if this can be achieved without significant hypoglycemia, other side effects, or excessive medication burden (due to complexity or cost that may limit adherence). Older adults and those with comorbid conditions or limited life expectancy may have A1C targets up to 8 percent (64 mmol/mol), 8.5 percent (69 mmol/mol), or even higher due to limited likelihood of benefit from intensive therapy balanced against the side effects of medications. Glycemic targets are reviewed in more detail separately.

• #5 Management of persistent hyperglycemia in type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus

  For most patients, we add a second medication when the individualized glycemic treatment goal is not achieved within three months with metformin plus lifestyle intervention. This is consistent with guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus guideline for medical management of hyperglycemia and underscores the importance of avoiding delay in treatment intensification. […] In some patients, early combination therapy is warranted for the kidney or heart protective benefit imparted by selected classes of glucose-lowering medications. […] Glycemic goals — Target A1C goals in patients with type 2 diabetes should be tailored to the individual, balancing the prospect of reduced microvascular complications with the adverse effects and cost of added treatments. Most younger patients (eg, aged <65 years) without established complications should have an A1C goal of <7 percent (53 mmol/mol) if this can be achieved without significant hypoglycemia, other side effects, or excessive medication burden (due to complexity or cost that may limit adherence). Older adults and those with comorbid conditions or limited life expectancy may have A1C targets up to 8 percent (64 mmol/mol), 8.5 percent (69 mmol/mol), or even higher due to limited likelihood of benefit from intensive therapy balanced against the side effects of medications. Glycemic targets are reviewed in more detail separately.

• #6 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  According to a 2018 guidance statement by the American College of Physicians (ACP), Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes. […] The ACP stated that evidence does not indicate that medication therapy to reduce the HbA1c level to 7% or less results in reduced mortality or in decreased macrovascular complications, such as heart attack or stroke, compared with a reduction to about 8%. […] In a 2021 joint consensus statement from the ADA, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK, the term remission, as it applies to type 2 diabetes, is defined as the presence of an HbA1c level below 6.5% ( 48 mmol/mol) at least 3 months after glucose-lowering pharmacotherapy has been halted. […] Early initiation of pharmacologic therapy is associated with improved glycemic control and reduced long-term complications in type 2 diabetes.

• #7 Hyperglycemia Treatment: Several Options And IV Fluids

  https://diabetesmantra.com/diabetes/treatment/hyperglycemia-treatment/

  A key component in managing hyperglycemia is dietary modification. Carbohydrate counting is crucial, as carbohydrates directly impact blood sugar levels. It involves keeping track of the amount of carbohydrates consumed at each meal and adjusting insulin accordingly. Adopting a balanced diet is equally important. A diet rich in fruits, vegetables, whole grains, and lean proteins, with limited intake of processed foods, refined sugars, and saturated fats, can help maintain stable blood sugar levels. […] Regularly checking blood sugar levels is crucial in managing hyperglycemia. This can be done using a traditional blood glucose meter, which involves pricking the finger to get a blood sample, or through continuous glucose monitoring systems (CGMs) that provide real-time blood sugar readings. Monitoring helps in making informed decisions about diet, exercise, and medication. It also helps in identifying patterns and trends in blood sugar levels. This is vital for long-term diabetes management.

• #8 Management of Blood Glucose in Type 2 Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0101/p29.html

  Evidence-based guidelines for the treatment of type 2 diabetes mellitus focus on three areas: intensive lifestyle intervention that includes at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet; aggressive management of cardiovascular risk factors (i.e., hypertension, dyslipidemia, and microalbuminuria) with the use of aspirin, statins, and angiotensin-converting enzyme inhibitors; and normalization of blood glucose levels (hemoglobin A1C level less than 7 percent). […] Metformin, which decreases hepatic glucose output and sensitizes peripheral tissues to insulin, has been shown to decrease mortality rates in patients with type 2 diabetes and is considered a first-line agent. […] A 6, 8 Metformin (Glucophage) is the only medication proven to reduce mortality rates in patients with type 2 diabetes. […] Metformin has been shown to decrease progression from impaired glucose tolerance to type 2 diabetes. […] It is the only hypoglycemic agent shown to reduce mortality rates in patients with type 2 diabetes.

• #9 Management of Blood Glucose in Type 2 Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0101/p29.html

  Evidence-based guidelines for the treatment of type 2 diabetes mellitus focus on three areas: intensive lifestyle intervention that includes at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet; aggressive management of cardiovascular risk factors (i.e., hypertension, dyslipidemia, and microalbuminuria) with the use of aspirin, statins, and angiotensin-converting enzyme inhibitors; and normalization of blood glucose levels (hemoglobin A1C level less than 7 percent). […] Metformin, which decreases hepatic glucose output and sensitizes peripheral tissues to insulin, has been shown to decrease mortality rates in patients with type 2 diabetes and is considered a first-line agent. […] A 6, 8 Metformin (Glucophage) is the only medication proven to reduce mortality rates in patients with type 2 diabetes. […] Metformin has been shown to decrease progression from impaired glucose tolerance to type 2 diabetes. […] It is the only hypoglycemic agent shown to reduce mortality rates in patients with type 2 diabetes.

• #10 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  Patients with newly diagnosed diabetes should participate in a comprehensive diabetes self-management education program, which includes individualized instruction on nutrition, physical activity, optimizing metabolic control, and preventing complications. […] Medical nutrition therapy (MNT) is the process by which a dietary plan is tailored for people with diabetes, based on medical, lifestyle, and personal factors. […] For patients with type 2 diabetes, body weight management should be considered as a therapeutic target in addition to glycemia. […] Weight loss improves glycemia through mitigation of insulin resistance and impaired beta cell function, two major metabolic perturbations evident in type 2 diabetes. […] Pharmacotherapy targeted solely for weight management is effective in patients with type 2 diabetes.

• #11 Hyperglycemia in diabetes – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/diagnosis-treatment/drc-20373635

  Your health care provider sets your target blood sugar range. For many people who have diabetes, Mayo Clinic generally recommends the following target blood sugar levels before meals: […] For many people who have diabetes, the American Diabetes Association generally recommends the following target blood sugar levels: […] Your target blood sugar range may differ, especially if you’re pregnant or you have other health problems that are caused by diabetes. […] Routine blood sugar monitoring with a blood glucose meter is the best way to be sure that your treatment plan is keeping your blood sugar within your target range. […] If your blood sugar level is 240 mg/dL (13.3 mmol/L) or above, use an over-the-counter urine ketones test kit. […] An A1C level of 7% or less means that your treatment plan is working and that your blood sugar was consistently within a healthy range.

• #12 Hyperglycemia Treatment: Several Options And IV Fluids

  https://diabetesmantra.com/diabetes/treatment/hyperglycemia-treatment/

  For those with Type 2 diabetes or at risk of developing it, maintaining a healthy weight can significantly improve the bodys ability to regulate blood sugar and respond to insulin. Even a modest weight loss of 5-10% can have a considerable impact on blood sugar control. This can be achieved through a combination of dietary changes, increased physical activity, and behavioral strategies. Its important to approach weight loss sustainably and healthily, focusing on gradual changes rather than rapid weight reduction. […] Stress has a significant impact on blood sugar levels. When stressed, the body releases hormones like cortisol and adrenaline, which can cause blood sugar levels to rise. This is especially problematic in individuals with diabetes who may already have difficulty regulating their blood sugar levels. Effective stress management strategies are therefore an important aspect of hyperglycemia treatment. Techniques such as mindfulness, meditation, yoga, and deep breathing exercises can help reduce stress. Regular participation in enjoyable activities and hobbies, as well as seeking support from friends, family, or professional counselors, can also be beneficial.

• #13 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  Although metformin is usually started for the management of hyperglycemia, it is also frequently an effective medication to promote modest weight loss. […] Insulin, rather than oral hypoglycemic agents, is often indicated for initial treatment of symptomatic or severe hyperglycemia. […] Insulin should also be initiated whenever there is a possibility of undiagnosed type 1 diabetes. […] The use of metformin as initial therapy is supported by meta-analyses of trials and observational studies evaluating the effects of oral or injectable diabetes medications as monotherapy on intermediate outcomes (A1C, body weight, lipid profiles) and adverse events. […] Cardiovascular benefit has been demonstrated for selected classes of diabetes medications, usually when added to metformin. […] Our approach is largely consistent with American and European guidelines. […] For patients who are not meeting glycemic targets despite diet, exercise, and metformin, combination therapy is necessary to achieve optimal results.

• #14 Individualizing Treatment of Hyperglycemia in Type 2 Diabetes | MDedge

  https://www.mdedge.com/jcomjournal/article/145784/diabetes/individualizing-treatment-hyperglycemia-type-2-diabetes

  The risk of intensive glycemic control may exceed the benefits in these patients, as they are at higher risk of hypoglycemia and polypharmacy. […] There is strong consensus that metformin is the preferred drug for monotherapy due to its long proven safety record, low cost, weight-reduction benefit, and potential cardiovascular advantages. […] As long as there are no contraindications, metformin should be recommended concurrent with lifestyle intervention at the time of diabetes diagnosis.

• #15 Management of Blood Glucose in Type 2 Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0101/p29.html

  Evidence-based guidelines for the treatment of type 2 diabetes mellitus focus on three areas: intensive lifestyle intervention that includes at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet; aggressive management of cardiovascular risk factors (i.e., hypertension, dyslipidemia, and microalbuminuria) with the use of aspirin, statins, and angiotensin-converting enzyme inhibitors; and normalization of blood glucose levels (hemoglobin A1C level less than 7 percent). […] Metformin, which decreases hepatic glucose output and sensitizes peripheral tissues to insulin, has been shown to decrease mortality rates in patients with type 2 diabetes and is considered a first-line agent. […] A 6, 8 Metformin (Glucophage) is the only medication proven to reduce mortality rates in patients with type 2 diabetes. […] Metformin has been shown to decrease progression from impaired glucose tolerance to type 2 diabetes. […] It is the only hypoglycemic agent shown to reduce mortality rates in patients with type 2 diabetes.

• #16 Management of Blood Glucose in Type 2 Diabetes Mellitus | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0101/p29.html

  Evidence-based guidelines for the treatment of type 2 diabetes mellitus focus on three areas: intensive lifestyle intervention that includes at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet; aggressive management of cardiovascular risk factors (i.e., hypertension, dyslipidemia, and microalbuminuria) with the use of aspirin, statins, and angiotensin-converting enzyme inhibitors; and normalization of blood glucose levels (hemoglobin A1C level less than 7 percent). […] Metformin, which decreases hepatic glucose output and sensitizes peripheral tissues to insulin, has been shown to decrease mortality rates in patients with type 2 diabetes and is considered a first-line agent. […] A 6, 8 Metformin (Glucophage) is the only medication proven to reduce mortality rates in patients with type 2 diabetes. […] Metformin has been shown to decrease progression from impaired glucose tolerance to type 2 diabetes. […] It is the only hypoglycemic agent shown to reduce mortality rates in patients with type 2 diabetes.

• #17 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  A literature review by Alfayez et al indicated that GLP-1 agonists, DPP-4 inhibitors, and SGLT-2 inhibitors put patients with type 2 diabetes at no additional cardiovascular risk. […] Metformin has proved effective and safe. […] Metformin lowers basal and postprandial plasma glucose levels. […] Patients on metformin have shown significant improvements in hemoglobin A1c and their lipid profile, especially when baseline values are abnormally elevated. […] In January 2017, the American College of Physicians (ACP) released a guideline update recommending the use of metformin as a first-line treatment for type 2 diabetes. […] A study by Vashisht et al that examined data from more than 246.5 million patients found that when used along with metformin therapy for type 2 diabetes, treatment with sulfonylureas, DPP-4 inhibitors, or thiazolidinediones was equally effective in reducing the HbA1c level to 7% or below that of total hemoglobin.

• #18

  https://www.jci.org/articles/view/142243

  Intensive glucose control did not significantly affect risks of macrovascular endpoints. […] Microvascular complications. DCCT and UKPDS demonstrated that enhanced glycemic control slows progression of microvascular complications (retinopathy, nephropathy, and neuropathy). […] Macrovascular complications. Long-term follow up in DCCT/EDIC and UKPDS strongly supports the conclusion that intensive glycemic control can in the fullness of time improve cardiovascular outcomes. […] Twelve classes of drugs are approved to treat T2D: biguanides (e.g., metformin), sulfonylureas, thiazolidinediones (TZDs), DPP4is, SGLT2is, GLP1RAs, insulins, -glucosidase inhibitors, dopaminergic antagonists, bile acid sequestrants, meglitinides, and amylinomimetics. […] The FDA requires sponsors to provide additional cardiovascular safety data: (a) a preapproval analysis to exclude an 80% increase in cardiovascular risk; and (b) a dedicated post-approval trial to exclude a 30% increase in risk.

• #19 Management of persistent hyperglycemia in type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus

  For most patients, we add a second medication when the individualized glycemic treatment goal is not achieved within three months with metformin plus lifestyle intervention. This is consistent with guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus guideline for medical management of hyperglycemia and underscores the importance of avoiding delay in treatment intensification. […] In some patients, early combination therapy is warranted for the kidney or heart protective benefit imparted by selected classes of glucose-lowering medications. […] Glycemic goals — Target A1C goals in patients with type 2 diabetes should be tailored to the individual, balancing the prospect of reduced microvascular complications with the adverse effects and cost of added treatments. Most younger patients (eg, aged <65 years) without established complications should have an A1C goal of <7 percent (53 mmol/mol) if this can be achieved without significant hypoglycemia, other side effects, or excessive medication burden (due to complexity or cost that may limit adherence). Older adults and those with comorbid conditions or limited life expectancy may have A1C targets up to 8 percent (64 mmol/mol), 8.5 percent (69 mmol/mol), or even higher due to limited likelihood of benefit from intensive therapy balanced against the side effects of medications. Glycemic targets are reviewed in more detail separately.

• #20 Individualizing Treatment of Hyperglycemia in Type 2 Diabetes | MDedge

  https://www.mdedge.com/jcomjournal/article/145784/diabetes/individualizing-treatment-hyperglycemia-type-2-diabetes

  Due to the progressive nature of T2DM, glycemic control on metformin monotherapy is likely to deteriorate over time, and there is no consensus as to what the second-line agent should be. […] A second agent should be selected based on glycemic goal and potential advantages and disadvantages of each agent for any given patient. […] If the patient progresses to the point where dual therapy does not provide adequate control, either a third non-insulin agent or insulin can be added. […] Although research is increasingly focusing on what the ideal number and sequence of drugs should be when managing T2DM, investigating all possible combinations in diverse patient populations is not feasible. […] Physicians therefore must continue to rely on clinical judgment to determine how to apply trial data to the treatment of individual patients.

• #21

  https://www.jci.org/articles/view/142243

  Intensive glucose control did not significantly affect risks of macrovascular endpoints. […] Microvascular complications. DCCT and UKPDS demonstrated that enhanced glycemic control slows progression of microvascular complications (retinopathy, nephropathy, and neuropathy). […] Macrovascular complications. Long-term follow up in DCCT/EDIC and UKPDS strongly supports the conclusion that intensive glycemic control can in the fullness of time improve cardiovascular outcomes. […] Twelve classes of drugs are approved to treat T2D: biguanides (e.g., metformin), sulfonylureas, thiazolidinediones (TZDs), DPP4is, SGLT2is, GLP1RAs, insulins, -glucosidase inhibitors, dopaminergic antagonists, bile acid sequestrants, meglitinides, and amylinomimetics. […] The FDA requires sponsors to provide additional cardiovascular safety data: (a) a preapproval analysis to exclude an 80% increase in cardiovascular risk; and (b) a dedicated post-approval trial to exclude a 30% increase in risk.

• #22

  https://www.jci.org/articles/view/142243

  These recommendations were not followed in practice. […] SGLT2is slowed progression of diabetic kidney disease, with meta-analysis estimating a hazard ratio of 0.62. […] The heart failure and renoprotection benefits were quantitatively larger and more consistently observed than improvement in MACE-3 outcomes. […] While glycemic control is a critical element of therapeutic regimens for T2D, other elements are also important, including lifestyle and cardiovascular medications. […] The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have jointly formulated therapeutic guidelines, which recommend individualizing HbA1c targets based on multiple considerations. […] ADA/EASD guidelines recommend metformin as first-line therapy for HbA1c-lowering in T2D and suggest four principal options for drugs to be added in patients not achieving their therapeutic target: DPP4is, GLP1RAs, SGLT2is, or TZDs. […] This intensive therapeutic strategy offers substantial potential to improve outcomes for T2D patients.

• #23 Diabetes Experts Release New Guidelines for Hyperglycemia in Type 2 Diabetes | Department of Medicine

  https://www.med.unc.edu/medicine/news/diabetes-experts-release-new-guidelines-for-hyperglycemia-in-type-2-diabetes/

  New recommendations, co-written by UNC School of Medicines John Buse, MD, PhD, cover the type of drugs patients should be prescribed and how providers can better help patients manage their health. […] The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have produced an updated consensus statement on how to manage hyperglycaemia (high blood sugar) in patients with type 2 diabetes. […] The new recommendations say type 2 diabetes patients with clinical cardiovascular disease should take a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium-glucose cotransporter 2 (SGLT2) inhibitor. […] There is also more focus on diet, weight loss medications, and weight loss surgery as strategies for diabetes control. […] Metformin continues to be the first-line recommended therapy for almost all patients with type 2 diabetes.

• #24 Diabetes Mellitus (DM) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm

  In people with diabetes and obesity, physicians should prescribe antihyperglycemic medications that promote weight loss (eg, GLP1 receptor agonists, SGLT-2 inhibitors, or a dual incretin agonist) or are weight-neutral (eg, dipeptidyl peptidase-4 inhibitors, metformin), if possible. […] Regular professional podiatric care, including trimming of toenails and calluses, is important for patients with sensory loss or circulatory impairment. […] All patients with diabetes mellitus should be vaccinated against Streptococcus pneumoniae, influenza virus, hepatitis B, varicella, and SARS-CoV-2 as per standard recommendations. […] Pancreas transplantation and transplantation of pancreatic islet cells are alternative means of insulin delivery.

• #25 Recommendations for the pharmacologic treatment of hyperglycemia in type 2 diabetes. Consensus document | Nefrología

  https://www.revistanefrologia.com/en-recommendations-for-pharmacologic-treatment-hyperglycemia-articulo-X2013251411051293

  We must not forget that hyperglycaemia is another risk factor in patients with diabetes and that there are other associated risk factors such as dyslipidaemia, high blood pressure, obesity or tobacco smoking. […] After the onset of treatment, or if changes are introduced, it is necessary to assess a series of aspects: metabolic control by the determination of HbA1c and with capillary glucose profiles. […] If the modifications have not been effective at achieving control targets in the first 3-month period, it will be necessary to intensify treatment and do not delay decision-making. […] Nowadays we have a series of drugs for treating diabetes, such as metformin, sulphonylureas, glinides, thiazolidinediones, disaccharidase inhibitors, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists.

• #26 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  A retrospective, nationwide cohort study found that metformin is associated with a low risk of mortality in patients who have diabetes and experience heart failure compared with treatment that includes a sulfonylurea or insulin. […] A study by Gross et al found no difference in benefit between drug classes in patients already on metformin and sulfonylurea. […] In a meta-analysis of 20 publications comprising 13,008 cancer patients with concurrent type 2 diabetes, Yin et al found that patients treated with metformin had better overall and cancer-specific survival than those treated with other types of glucose-lowering agents. […] The use of pioglitazone for more than 2 years is weakly associated with an increased bladder cancer risk, with the highest risk among patients who took pioglitazone the longest and at the highest cumulative doses.

• #27 Diabetes Experts Release New Guidelines for Hyperglycemia in Type 2 Diabetes | Department of Medicine

  https://www.med.unc.edu/medicine/news/diabetes-experts-release-new-guidelines-for-hyperglycemia-in-type-2-diabetes/

  New recommendations, co-written by UNC School of Medicines John Buse, MD, PhD, cover the type of drugs patients should be prescribed and how providers can better help patients manage their health. […] The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have produced an updated consensus statement on how to manage hyperglycaemia (high blood sugar) in patients with type 2 diabetes. […] The new recommendations say type 2 diabetes patients with clinical cardiovascular disease should take a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium-glucose cotransporter 2 (SGLT2) inhibitor. […] There is also more focus on diet, weight loss medications, and weight loss surgery as strategies for diabetes control. […] Metformin continues to be the first-line recommended therapy for almost all patients with type 2 diabetes.

• #28 Diabetes Experts Release New Guidelines for Hyperglycemia in Type 2 Diabetes | Department of Medicine

  https://www.med.unc.edu/medicine/news/diabetes-experts-release-new-guidelines-for-hyperglycemia-in-type-2-diabetes/

  Regarding medication management, for patients with clinical cardiovascular disease, a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. […] GLP-1 receptor agonists are generally recommended as the first injectable medication, except in settings where type 1 diabetes is suspected.

• #29 Management of Diabetes and Hyperglycemia in Hospitalized Patients – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279093/

  Diabetes is the most prevalent metabolic disorder, and in 2021, the International Diabetes Federation estimated that it affected 537 million adults globally. […] Hyperglycemia, defined as a blood glucose greater than 140 mg/dl (7.8 mmol/l), is reported in 22-46% of non-critically ill hospitalized patients. Extensive data indicates that inpatient hyperglycemia, in patients with or without a prior diagnosis of diabetes, is associated with an increased risk of complications and mortality. […] Insulin remains the best way to control hyperglycemia in the inpatient setting, especially in critically ill patients. […] The use of GLP-1 receptor agonists was not recommended in previous guidelines because of the need for more safety and efficacy studies in the inpatient setting. However, increasing evidence indicates that treatment with oral agents such as DPP4 inhibitors, alone or combined with basal insulin, is safe and effective in general medicine and surgery patients with mild to moderate hyperglycemia.

• #30 About Insulin for Diabetes or Treatment-Related Hyperglycemia | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/patient-education/about-insulin-for-diabetes-or-treatment-related-hyperglycemia

  Insulin is a hormone that lets glucose (sugar) go from your bloodstream into your cells. Your pancreas makes insulin and releases it into the bloodstream. Your cells need glucose for energy. If your body does not have enough insulin, glucose stays in your bloodstream. This causes hyperglycemia (high blood sugar). […] People with T1DM must always take exogenous (ex-AH-jin-us) insulin. Exogenous insulin is medicine that you inject. It acts like insulin and replaces the insulin your body cannot make. […] People with T2DM may need oral medicine to help manage blood glucose levels. As your pancreas makes less insulin over time you may also need exogenous insulin. […] Some diabetes medicine makes your pancreas release more insulin. But these medicines will not work if your pancreas cannot make any more insulin. If so, you’ll need to use exogenous insulin to control your blood glucose levels.

• #31 Initial Management of Severe Hyperglycemia in Type 2 Diabetes – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK278997/

  Type 2 diabetes mellitus (DM) is a common disease affecting 30.3 million people, 9.4% of the US population. Of these, an estimated 7 million people are undiagnosed. […] Symptoms of uncontrolled hyperglycemia include polyuria, polydipsia, blurry vision and possibly dehydration and weight loss. […] Insulin therapy is the initial management choice for patients presenting with hyperglycemia and catabolic symptoms including weight loss. […] For a severely hyperglycemic patient, with a catabolic presentation that usually includes moderate to severe volume depletion, the first therapeutic step is rehydration, usually with intravenous saline. […] After adequate hydration, therapy with physiologic doses of insulin (0.3-0.4 units per kilogram body weight daily) is recommended. […] The ideal treatment regimen would be a combination of a long-acting basal insulin plus multiple premeal prandial bolus injections to manage meal-related insulin requirements and correction of pre-meal hyperglycemia, referred to as basal-bolus insulin therapy.

• #32 Diabetes Mellitus (DM) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm

  The goal of diabetes treatment is control of hyperglycemia to relieve symptoms and prevent complications while minimizing hypoglycemic episodes. […] Key elements of treatment for all patients are patient education, diet, exercise, weight loss, and monitoring of glucose control. […] Insulin is indicated as initial therapy for women with type 2 diabetes who are pregnant and for patients who present with acute metabolic decompensation, such as hyperosmolar hyperglycemic state or diabetic ketoacidosis (DKA). […] Education is crucial to optimizing care. […] Adjusting diet to individual circumstances can help patients control fluctuations in their glucose level and, for patients with type 2 diabetes mellitus, lose weight. […] Physical activity should increase incrementally to whatever level a patient can tolerate.

• #33 Diabetes Mellitus (DM) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm

  The goal of diabetes treatment is control of hyperglycemia to relieve symptoms and prevent complications while minimizing hypoglycemic episodes. […] Key elements of treatment for all patients are patient education, diet, exercise, weight loss, and monitoring of glucose control. […] Insulin is indicated as initial therapy for women with type 2 diabetes who are pregnant and for patients who present with acute metabolic decompensation, such as hyperosmolar hyperglycemic state or diabetic ketoacidosis (DKA). […] Education is crucial to optimizing care. […] Adjusting diet to individual circumstances can help patients control fluctuations in their glucose level and, for patients with type 2 diabetes mellitus, lose weight. […] Physical activity should increase incrementally to whatever level a patient can tolerate.

• #34 Initial Management of Severe Hyperglycemia in Type 2 Diabetes – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK278997/

  Type 2 diabetes mellitus (DM) is a common disease affecting 30.3 million people, 9.4% of the US population. Of these, an estimated 7 million people are undiagnosed. […] Symptoms of uncontrolled hyperglycemia include polyuria, polydipsia, blurry vision and possibly dehydration and weight loss. […] Insulin therapy is the initial management choice for patients presenting with hyperglycemia and catabolic symptoms including weight loss. […] For a severely hyperglycemic patient, with a catabolic presentation that usually includes moderate to severe volume depletion, the first therapeutic step is rehydration, usually with intravenous saline. […] After adequate hydration, therapy with physiologic doses of insulin (0.3-0.4 units per kilogram body weight daily) is recommended. […] The ideal treatment regimen would be a combination of a long-acting basal insulin plus multiple premeal prandial bolus injections to manage meal-related insulin requirements and correction of pre-meal hyperglycemia, referred to as basal-bolus insulin therapy.

• #35

  https://www.jci.org/articles/view/142243

  This Review discusses current guidelines for use of the 12 classes of drugs approved to promote glycemic control in patients with type 2 diabetes. […] Treatment aims to prevent or delay occurrence of microvascular and macrovascular complications the main causes of morbidity and mortality in T2D. […] The Diabetes Control and Complications Trial (DCCT) demonstrated that enhanced glycemic control decreased risk of chronic microvascular complications. […] The United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that enhanced glycemic control is beneficial in T2D. […] ACCORD trial. In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, T2D patients with high cardiovascular risk were randomized between standard therapy (targeting HbA1c of 7.0%7.9%) and intensive therapy (targeting HbA1c 6.0%).

• #36 Recommendations for the pharmacologic treatment of hyperglycemia in type 2 diabetes. Consensus document | Nefrología

  https://www.revistanefrologia.com/en-recommendations-for-pharmacologic-treatment-hyperglycemia-articulo-X2013251411051293

  The initial drug treatment will vary depending on the previous degree of control, the patient’s age, whether there are associated diseases, and the concomitant use of other medication. […] In patients with severe hyperglycaemia, it is often necessary to begin insulin treatment alone or in combination with metformin. […] The treatment is divided into three treatment steps. First, if the hyperglycaemia is not severe, metformin is the medication of choice. […] If blood glucose levels are high, the initial treatment must begin with several oral drugs in combination or with insulin. […] The second step involves adding a second synergistic drug. […] Lastly, the third step involves introducing basal insulin as the option of choice rather than triple oral therapy.

• #37 Hyperglycemia in diabetes – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631

  Keeping blood sugar in a healthy range can help prevent many diabetes-related complications. Long-term complications of hyperglycemia that isn’t treated include: cardiovascular disease, nerve damage (neuropathy), kidney damage (diabetic nephropathy) or kidney failure, damage to the blood vessels of the retina (diabetic retinopathy) that could lead to blindness, feet problems caused by damaged nerves or poor blood flow that can lead to serious skin infections, ulcerations and, in some severe cases, amputation, bone and joint problems, teeth and gum infections. […] If blood sugar rises very high or if high blood sugar levels are not treated, it can lead to two serious conditions. Diabetic ketoacidosis. This condition develops when you don’t have enough insulin in your body. When this happens, glucose can’t enter your cells for energy. Your blood sugar level rises, and your body begins to break down fat for energy.

• #38 Hyperosmolar Hyperglycemic State Treatment & Management: Approach Considerations, Standard Care for Dehydration and Altered Mental Status, Insulin Therapy for Correction of Hyperglycemia

  https://emedicine.medscape.com/article/1914705-treatment

  Diagnosis and management guidelines for hyperglycemic crises are available from the American Diabetes Association. […] The main goals in the treatment of hyperosmolar hyperglycemic state (HHS) are as follows: To vigorously rehydrate the patient while maintaining electrolyte homeostasis […] To correct hyperglycemia […] To treat underlying diseases […] To monitor and assist cardiovascular, pulmonary, renal, and central nervous system (CNS) function. […] Although many patients with HHS respond to fluids alone, IV insulin in dosages similar to those used in diabetic ketoacidosis (DKA) can facilitate correction of hyperglycemia. […] All patients diagnosed with HHS require hospitalization; virtually all need admission to a monitored unit managed by medicine, pediatrics, or the intensive care unit (ICU) for close monitoring.

• #39 Hyperglycemia in diabetes | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/hyperglycemia-in-diabetes?content_id=CON-20373616

  If you have signs and symptoms of diabetic ketoacidosis or hyperosmolar hyperglycemic state, you may be treated in the emergency room or admitted to the hospital. Emergency treatment can lower your blood sugar to a normal range. Treatment usually includes: fluid replacement, electrolyte replacement, insulin therapy. […] Talk to your health care provider about managing your blood sugar. Understand how different treatments can help keep your glucose levels within your target range. Your health care provider may suggest the following: get physical, take your medication as directed, follow your diabetes eating plan, check your blood sugar, adjust your insulin doses.

• #40 Hyperglycemia in diabetes | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/hyperglycemia-in-diabetes?content_id=CON-20373616

  If you have signs and symptoms of diabetic ketoacidosis or hyperosmolar hyperglycemic state, you may be treated in the emergency room or admitted to the hospital. Emergency treatment can lower your blood sugar to a normal range. Treatment usually includes: fluid replacement, electrolyte replacement, insulin therapy. […] Talk to your health care provider about managing your blood sugar. Understand how different treatments can help keep your glucose levels within your target range. Your health care provider may suggest the following: get physical, take your medication as directed, follow your diabetes eating plan, check your blood sugar, adjust your insulin doses.

• #41 Hyperglycemia in diabetes | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/hyperglycemia-in-diabetes?content_id=CON-20373616

  If you have signs and symptoms of diabetic ketoacidosis or hyperosmolar hyperglycemic state, you may be treated in the emergency room or admitted to the hospital. Emergency treatment can lower your blood sugar to a normal range. Treatment usually includes: fluid replacement, electrolyte replacement, insulin therapy. […] Talk to your health care provider about managing your blood sugar. Understand how different treatments can help keep your glucose levels within your target range. Your health care provider may suggest the following: get physical, take your medication as directed, follow your diabetes eating plan, check your blood sugar, adjust your insulin doses.

• #42 Hyperosmolar Hyperglycemic State Treatment & Management: Approach Considerations, Standard Care for Dehydration and Altered Mental Status, Insulin Therapy for Correction of Hyperglycemia

  https://emedicine.medscape.com/article/1914705-treatment

  Diagnosis and management guidelines for hyperglycemic crises are available from the American Diabetes Association. […] The main goals in the treatment of hyperosmolar hyperglycemic state (HHS) are as follows: To vigorously rehydrate the patient while maintaining electrolyte homeostasis […] To correct hyperglycemia […] To treat underlying diseases […] To monitor and assist cardiovascular, pulmonary, renal, and central nervous system (CNS) function. […] Although many patients with HHS respond to fluids alone, IV insulin in dosages similar to those used in diabetic ketoacidosis (DKA) can facilitate correction of hyperglycemia. […] All patients diagnosed with HHS require hospitalization; virtually all need admission to a monitored unit managed by medicine, pediatrics, or the intensive care unit (ICU) for close monitoring.

• #43 Hyperosmolar Hyperglycemic State Treatment & Management: Approach Considerations, Standard Care for Dehydration and Altered Mental Status, Insulin Therapy for Correction of Hyperglycemia

  https://emedicine.medscape.com/article/1914705-treatment

  Frequent reevaluation of the patients clinical and laboratory parameters is necessary. […] All patients with HHS require IV insulin therapy; however, immediate treatment with insulin is contraindicated in the initial management of patients with HHS. […] IV insulin administration is accomplished most effectively in the ICU, where cardiovascular and respiratory support is available if needed. […] Once the patient is alert and able to eat, an insulin regimen consisting of short-/rapid-acting insulin and long-acting insulin is needed to wean the patient off of IV insulin therapy and to control glucose levels. […] All patients who have experienced HHS will probably require intensive management of their diabetes initially, and this includes insulin therapy.

• #44 Diabetes: What It Is, Causes, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/7104-diabetes

  When glucose is in your bloodstream, it needs help a key to reach its final destination. This key is insulin (a hormone). If your pancreas isnt making enough insulin or your body isnt using it properly, glucose builds up in your bloodstream, causing high blood sugar (hyperglycemia). […] Acute diabetes complications that can be life-threatening include: […] Hyperosmolar hyperglycemic state (HHS): This complication mainly affects people with Type 2 diabetes. It happens when your blood sugar levels are very high (over 600 milligrams per deciliter or mg/dL) for a long period, leading to severe dehydration and confusion. It requires immediate medical treatment. […] Diabetes-related ketoacidosis (DKA): This complication mainly affects people with Type 1 diabetes or undiagnosed T1D. It happens when your body doesnt have enough insulin. If your body doesnt have insulin, it cant use glucose for energy, so it breaks down fat instead. This process eventually releases substances called ketones, which turn your blood acidic. This causes labored breathing, vomiting and loss of consciousness. DKA requires immediate medical treatment. […] Studies show that people with diabetes may be able to reduce their risk of complications by consistently keeping their A1c levels below 7%.

• #45

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-endocrine-electrolytes/hyperglycemia

  Average fluid loss in DKA 3-6 liters and HHS 8-12 liters. […] Insulin therapy involves the administration of regular insulin via IV infusion or subcutaneous injections. […] Insulin therapy should only be started after adequate fluid resuscitation. […] Patients with uncomplicated hyperglycemia can typically be managed as an outpatient. […] All patients with DKA and HHS require hospital admission.

• #46

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-endocrine-electrolytes/hyperglycemia

  Average fluid loss in DKA 3-6 liters and HHS 8-12 liters. […] Insulin therapy involves the administration of regular insulin via IV infusion or subcutaneous injections. […] Insulin therapy should only be started after adequate fluid resuscitation. […] Patients with uncomplicated hyperglycemia can typically be managed as an outpatient. […] All patients with DKA and HHS require hospital admission.

• #47 Hyperglycemia – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/hyperglycemia_treatment/

  Severe hyperglycemia in T2DM Give fluids and IV insulin, correct electrolyte imbalances and address any underlying cause. […] The treatment is similar to DKA. Individualized IV fluid administration is recommended as older patients. Potassium can be managed as per DKA. IV insulin (at similar doses to DKA) is still recommended; however, the role of insulin is primarily to help normalize glucose levels. […] Hypoglycemia (most common complication of treatment). […] Most patients diagnosed with DKA or HHS require admission. […] Evidence and protocols regarding appropriate glucose levels for the safe ED discharge of noncritically ill patients with hyperglycemia are lacking. […] Patients with stress-induced hyperglycemia should be closely followed once discharged, as they are at increased risk of developing incident type 2 diabetes.

• #48 Hyperglycemia – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/hyperglycemia_treatment/

  Severe hyperglycemia in T2DM Give fluids and IV insulin, correct electrolyte imbalances and address any underlying cause. […] The treatment is similar to DKA. Individualized IV fluid administration is recommended as older patients. Potassium can be managed as per DKA. IV insulin (at similar doses to DKA) is still recommended; however, the role of insulin is primarily to help normalize glucose levels. […] Hypoglycemia (most common complication of treatment). […] Most patients diagnosed with DKA or HHS require admission. […] Evidence and protocols regarding appropriate glucose levels for the safe ED discharge of noncritically ill patients with hyperglycemia are lacking. […] Patients with stress-induced hyperglycemia should be closely followed once discharged, as they are at increased risk of developing incident type 2 diabetes.

• #49 Hyperglycemia – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/hyperglycemia_treatment/

  Metabolic / Endocrine […] Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the main hyperglycemic emergencies. […] Treatment of DKA and HHS is focused on fluid resuscitation, addressing potassium imbalances, correcting ketoacidosis (in DKA), normalizing glucose and other electrolyte levels, addressing the underlying precipitant, and preventing complications. […] Severe and symptomatic hyperglycemia – administer insulin (both a low dose of regular or rapid-acting insulin and long-acting insulin) – consult endocrine or internal medicine. […] Type 2 Diabetes (T2DM) diagnosed in ED – control acute symptoms, address any underlying precipitant/cause and consider prescribing metformin 500mg BID (contraindicated if GFR < 30mL/min) and/or referring to primary care provider for urgent follow-up.

• #50 High blood sugar (hyperglycemia) and diabetic ketoacidosis

  https://www.diabinfo.de/en/living-with-diabetes/treatment/high-blood-sugar-hyperglycemia-and-diabetic-ketoacidosis.html

  If the result of the ketone body test comes back positive, countermeasures must be initiated rapidly. In order to be able to act appropriately in an emergency, people with type 1 diabetes should have talked with their doctor beforehand. […] Diabetic ketoacidosis can develop for a variety of reasons. In the event of ketoacidosis, there is no or almost no insulin available in the body. […] In type 2 diabetes, diabetic ketoacidosis is rare. Causes can be severe infections, heavy alcohol consumption with and without metformin therapy, and severe lack of insulin in prolonged type 2 diabetes. […] The blood sugar levels of patients with type 2 diabetes can also spike when there is not enough insulin available or it is not effective. However, since their pancreas generally releases at least small amounts of insulin, there is not a massive buildup of ketone bodies as in ketoacidosis. […] Hyperosmolar hyperglycemic syndrome can be triggered by infections, acute cardiovascular events, vomiting, severe diarrhea, kidney diseases, large quantities of sugar-containing drinks, and medications such as diuretics, certain psychoactive drugs, and glucocorticoids.

• #51 Management of Diabetes and Hyperglycemia in Hospitalized Patients – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279093/

  Diabetes is the most prevalent metabolic disorder, and in 2021, the International Diabetes Federation estimated that it affected 537 million adults globally. […] Hyperglycemia, defined as a blood glucose greater than 140 mg/dl (7.8 mmol/l), is reported in 22-46% of non-critically ill hospitalized patients. Extensive data indicates that inpatient hyperglycemia, in patients with or without a prior diagnosis of diabetes, is associated with an increased risk of complications and mortality. […] Insulin remains the best way to control hyperglycemia in the inpatient setting, especially in critically ill patients. […] The use of GLP-1 receptor agonists was not recommended in previous guidelines because of the need for more safety and efficacy studies in the inpatient setting. However, increasing evidence indicates that treatment with oral agents such as DPP4 inhibitors, alone or combined with basal insulin, is safe and effective in general medicine and surgery patients with mild to moderate hyperglycemia.

• #52 Management of Diabetes and Hyperglycemia in Hospitalized Patients – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279093/

  Diabetes is the most prevalent metabolic disorder, and in 2021, the International Diabetes Federation estimated that it affected 537 million adults globally. […] Hyperglycemia, defined as a blood glucose greater than 140 mg/dl (7.8 mmol/l), is reported in 22-46% of non-critically ill hospitalized patients. Extensive data indicates that inpatient hyperglycemia, in patients with or without a prior diagnosis of diabetes, is associated with an increased risk of complications and mortality. […] Insulin remains the best way to control hyperglycemia in the inpatient setting, especially in critically ill patients. […] The use of GLP-1 receptor agonists was not recommended in previous guidelines because of the need for more safety and efficacy studies in the inpatient setting. However, increasing evidence indicates that treatment with oral agents such as DPP4 inhibitors, alone or combined with basal insulin, is safe and effective in general medicine and surgery patients with mild to moderate hyperglycemia.

• #53 Management of Diabetes and Hyperglycemia in Hospitalized Patients – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279093/

  Several studies and meta-analyses have shown that attempting tight glycemic control using intensive insulin therapy is associated with an increased risk of hypoglycemia, which has been associated with increased morbidity and mortality in hospitalized patients. […] The American Diabetes Association (ADA) recommends that once therapy is initiated, a glycemic goal of 140-180 mg/dL (7.8-10.0 mmol/L) is recommended for most critically ill (ICU) individuals with hyperglycemia. […] For non-critically ill (non-ICU) individuals, a glycemic goal of 100-180 mg/dL (5.6-10.0 mmol/L) is recommended, if achieved without significant hypoglycemia.

• #54 Management of Diabetes and Hyperglycemia in Hospitalized Patients – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279093/

  Several studies and meta-analyses have shown that attempting tight glycemic control using intensive insulin therapy is associated with an increased risk of hypoglycemia, which has been associated with increased morbidity and mortality in hospitalized patients. […] The American Diabetes Association (ADA) recommends that once therapy is initiated, a glycemic goal of 140-180 mg/dL (7.8-10.0 mmol/L) is recommended for most critically ill (ICU) individuals with hyperglycemia. […] For non-critically ill (non-ICU) individuals, a glycemic goal of 100-180 mg/dL (5.6-10.0 mmol/L) is recommended, if achieved without significant hypoglycemia.

• #55 Inpatient Hyperglycemia Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/inpatient-hyperglycemia-guideline-resources

  In adult patients using insulin pump therapy for diabetes management prior to admission for non-critical illness, we suggest that these patients continue insulin pump therapy rather than changing to subcutaneous (SC) BBI therapy in hospitals with access to personnel with expertise in insulin pump therapy. […] In adult patients with diabetes who are hospitalized for non-critical illness, we suggest providing inpatient diabetes education as part of a comprehensive diabetes discharge-planning process, rather than not providing inpatient diabetes education. […] For adult patients with diabetes undergoing elective surgical procedures, we suggest targeting preoperative hemoglobin A1c (HbA1c) levels 8% (63.9 mmol/mol) and BG concentrations 100-180 mg/dL (5.6-10 mmol/L). […] In adult patients hospitalized for non-critical illness who are receiving enteral nutrition with diabetes-specific and non-specific formulations, we suggest using NPH-based or basal bolus regimens.

• #56 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter16

  A number of studies have demonstrated that inpatient hyperglycemia is associated with increased morbidity and mortality in noncritically ill hospitalized people. […] Current recommendations are based mostly on retrospective studies, clinical experience and judgement. Glycemic targets for hospitalized people with diabetes are modestly higher than those routinely advised for outpatients with diabetes given that the hospital setting presents unique challenges for the management of hyperglycemia, such as variations in patient nutritional status and the presence of acute illness. […] The management of individuals with diabetes at the time of surgery poses a number of challenges. Acute hyperglycemia is common secondary to the physiological stress associated with surgery. […] Given the data supporting tighter perioperative glycemic control during major surgeries and the compelling data showing the adverse effects of hyperglycemia, it is reasonable to target glycemic levels between 5.0 to 10.0mmol/L for minor and moderate surgeries in patients with known diabetes.

• #57 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter16

  A number of studies have demonstrated that inpatient hyperglycemia is associated with increased morbidity and mortality in noncritically ill hospitalized people. […] Current recommendations are based mostly on retrospective studies, clinical experience and judgement. Glycemic targets for hospitalized people with diabetes are modestly higher than those routinely advised for outpatients with diabetes given that the hospital setting presents unique challenges for the management of hyperglycemia, such as variations in patient nutritional status and the presence of acute illness. […] The management of individuals with diabetes at the time of surgery poses a number of challenges. Acute hyperglycemia is common secondary to the physiological stress associated with surgery. […] Given the data supporting tighter perioperative glycemic control during major surgeries and the compelling data showing the adverse effects of hyperglycemia, it is reasonable to target glycemic levels between 5.0 to 10.0mmol/L for minor and moderate surgeries in patients with known diabetes.

• #58 Inpatient Hyperglycemia Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/inpatient-hyperglycemia-guideline-resources

  In most adult patients with hyperglycemia (with or without known type 2 diabetes [T2D]) hospitalized for a non-critical illness, we suggest that scheduled insulin therapy be used instead of non-insulin therapies for glycemic management. […] In adults with no prior history of diabetes hospitalized for non-critical illness with hyperglycemia (defined as BG 140 mg/dL [7.8 mmol/L]) during hospitalization, we suggest initial therapy with correctional insulin over scheduled insulin therapy (defined as basal or basal/bolus insulin) to maintain glucose targets in the range of 100-180 mg/dL (5.6-10.0 mmol/L). […] In adults with diabetes treated with diet or non-insulin diabetes medications prior to admission, we suggest initial therapy with correctional insulin or scheduled insulin therapy to maintain glucose targets in the range of 100-180 mg/dL (5.6-10.0 mmol/L). […] In adults with insulin-treated diabetes prior to admission who are hospitalized for non-critical illness, we recommend continuation of the scheduled insulin regimen modified for nutritional status and severity of illness to maintain glucose targets in the range of 100-180 mg/dL (5.6-10.0 mmol/L).

• #59 Inpatient Hyperglycemia Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/inpatient-hyperglycemia-guideline-resources

  In most adult patients with hyperglycemia (with or without known type 2 diabetes [T2D]) hospitalized for a non-critical illness, we suggest that scheduled insulin therapy be used instead of non-insulin therapies for glycemic management. […] In adults with no prior history of diabetes hospitalized for non-critical illness with hyperglycemia (defined as BG 140 mg/dL [7.8 mmol/L]) during hospitalization, we suggest initial therapy with correctional insulin over scheduled insulin therapy (defined as basal or basal/bolus insulin) to maintain glucose targets in the range of 100-180 mg/dL (5.6-10.0 mmol/L). […] In adults with diabetes treated with diet or non-insulin diabetes medications prior to admission, we suggest initial therapy with correctional insulin or scheduled insulin therapy to maintain glucose targets in the range of 100-180 mg/dL (5.6-10.0 mmol/L). […] In adults with insulin-treated diabetes prior to admission who are hospitalized for non-critical illness, we recommend continuation of the scheduled insulin regimen modified for nutritional status and severity of illness to maintain glucose targets in the range of 100-180 mg/dL (5.6-10.0 mmol/L).

• #60 Best Practices for Managing Steroid-Induced Hyperglycemia | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2024/03/best-practices-for-managing-steroid-induced-hyperglycemia

  Widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids (steroids) are a critical component of many medical treatment protocols. […] However, high-dose or long-term use is associated with the risk of developing Type 2 diabetes because steroids cause both insulin resistance and hyperglycemia. […] According to a meta-analysis published in Nature Review Endocrinology, among patients with no prior history of DM who were prescribed steroids for a month or longer, the incidence of steroid-induced hyperglycemia was 32 percent. […] Similarly, individuals with previously well-managed DM may experience dysregulated glucose levels if they require a course of steroids. […] While many factors drive up blood sugar in the inpatient setting, patients on steroids often have glucose levels greater than 200 mg/dL.

• #61 Best Practices for Managing Steroid-Induced Hyperglycemia | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2024/03/best-practices-for-managing-steroid-induced-hyperglycemia

  Widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids (steroids) are a critical component of many medical treatment protocols. […] However, high-dose or long-term use is associated with the risk of developing Type 2 diabetes because steroids cause both insulin resistance and hyperglycemia. […] According to a meta-analysis published in Nature Review Endocrinology, among patients with no prior history of DM who were prescribed steroids for a month or longer, the incidence of steroid-induced hyperglycemia was 32 percent. […] Similarly, individuals with previously well-managed DM may experience dysregulated glucose levels if they require a course of steroids. […] While many factors drive up blood sugar in the inpatient setting, patients on steroids often have glucose levels greater than 200 mg/dL.

• #62

  https://link.springer.com/article/10.1007/s13300-024-01628-0

  The importance of monitoring for and recognizing medication-induced hyperglycemia is significant. […] Successful management of steroid-induced hyperglycemia begins with appropriate monitoring of blood glucose. […] Patient education, discussion of glucose monitoring, involvement of allied health care, and ensuring that all members of the health care team are aware of hyperglycemia risks are critical factors to ensure proper management. […] The exact incidence of medication-induced hyperglycemia and diabetes is unknown, but there is evidence that glucocorticoids, antipsychotic medications, cardiovascular medications, certain anti-infectives, antineoplastic medications, immunosuppressive agents, and hormonal treatment are associated with changes in glucose metabolism and increased incidence of hyperglycemia and/or diabetes. […] Assessment of underlying patient risk factors, dose and duration of a medication that can cause hyperglycemia or diabetes, and pre-existing comorbidities are key factors to evaluate risk of medication-induced hyperglycemia and diabetes.

• #63 Inpatient Hyperglycemia Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/inpatient-hyperglycemia-guideline-resources

  In adult patients using insulin pump therapy for diabetes management prior to admission for non-critical illness, we suggest that these patients continue insulin pump therapy rather than changing to subcutaneous (SC) BBI therapy in hospitals with access to personnel with expertise in insulin pump therapy. […] In adult patients with diabetes who are hospitalized for non-critical illness, we suggest providing inpatient diabetes education as part of a comprehensive diabetes discharge-planning process, rather than not providing inpatient diabetes education. […] For adult patients with diabetes undergoing elective surgical procedures, we suggest targeting preoperative hemoglobin A1c (HbA1c) levels 8% (63.9 mmol/mol) and BG concentrations 100-180 mg/dL (5.6-10 mmol/L). […] In adult patients hospitalized for non-critical illness who are receiving enteral nutrition with diabetes-specific and non-specific formulations, we suggest using NPH-based or basal bolus regimens.

• #64 Initial Management of Severe Hyperglycemia in Type 2 Diabetes – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK278997/

  Until more education is possible, the need to limit high glycemic-load carbohydrate intake (such as with sweetened beverages and juice) should be strongly reinforced with counseling. […] Initial diabetes therapy includes counseling for lifestyle and diabetic nutritional interventions. In the absence of contraindications, starting therapy with metformin is recommended as an adjunctive therapy with insulin to reduce insulin requirements and minimize weight gain in patients with type 2 diabetes. […] Transitioning from insulin to metformin and other non-insulin antihyperglycemic medications may be considered if the patient initially presented with an A1c 10% and if the patient is able to achieve a reasonable A1c goal that is corroborated by the SMBG data while using a total daily insulin dose that is low. […] Among the non-insulin antihyperglycemic medications, clinicians should be aware of the risk of DKA associated with the sodium-glucose cotransporter 2 (SGLT2) inhibitors, which provide insulin-independent glucose lowering by blocking the SGLT2s glucose reabsorption in the proximal renal tubule.

• #65 Best Practices for Managing Steroid-Induced Hyperglycemia | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2024/03/best-practices-for-managing-steroid-induced-hyperglycemia

  Steroids have a cumulative effect on blood sugar, so initiating insulin therapy on the same day as the initial steroid dose provides much better glycemic outcomes. […] Furthermore, steroids cause significant postprandial hyperglycemia. […] Patients do better when we take the time to explain the effects of steroids and the benefits of insulin, says Colo.

• #66 Best Practices for Managing Steroid-Induced Hyperglycemia | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2024/03/best-practices-for-managing-steroid-induced-hyperglycemia

  Steroids have a cumulative effect on blood sugar, so initiating insulin therapy on the same day as the initial steroid dose provides much better glycemic outcomes. […] Furthermore, steroids cause significant postprandial hyperglycemia. […] Patients do better when we take the time to explain the effects of steroids and the benefits of insulin, says Colo.

• #67 Individualizing Treatment of Hyperglycemia in Type 2 Diabetes | MDedge

  https://www.mdedge.com/jcomjournal/article/145784/diabetes/individualizing-treatment-hyperglycemia-type-2-diabetes

  Objective: To summarize key issues relevant to managing hyperglycemia in patients with type 2 diabetes mellitus (T2DM) and review a strategy for initiating and intensifying therapy. […] The 6 most widely used pharmacologic treatment options for hyperglycemia in T2DM are metformin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, and insulin. […] Recent guidelines stress the importance of an individualized, patient-centered approach to managing hyperglycemia in T2DM, although sufficient guidance for nonspecialists on how to individualize treatment is often lacking. […] For patients with no contraindications, metformin should be recommended concurrent with lifestyle intervention at the time of diabetes diagnosis.

• #68 Management of persistent hyperglycemia in type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus

  For most patients, we add a second medication when the individualized glycemic treatment goal is not achieved within three months with metformin plus lifestyle intervention. This is consistent with guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus guideline for medical management of hyperglycemia and underscores the importance of avoiding delay in treatment intensification. […] In some patients, early combination therapy is warranted for the kidney or heart protective benefit imparted by selected classes of glucose-lowering medications. […] Glycemic goals — Target A1C goals in patients with type 2 diabetes should be tailored to the individual, balancing the prospect of reduced microvascular complications with the adverse effects and cost of added treatments. Most younger patients (eg, aged <65 years) without established complications should have an A1C goal of <7 percent (53 mmol/mol) if this can be achieved without significant hypoglycemia, other side effects, or excessive medication burden (due to complexity or cost that may limit adherence). Older adults and those with comorbid conditions or limited life expectancy may have A1C targets up to 8 percent (64 mmol/mol), 8.5 percent (69 mmol/mol), or even higher due to limited likelihood of benefit from intensive therapy balanced against the side effects of medications. Glycemic targets are reviewed in more detail separately.

• #69 Diabetes Experts Release New Guidelines for Hyperglycemia in Type 2 Diabetes | Department of Medicine

  https://www.med.unc.edu/medicine/news/diabetes-experts-release-new-guidelines-for-hyperglycemia-in-type-2-diabetes/

  New recommendations, co-written by UNC School of Medicines John Buse, MD, PhD, cover the type of drugs patients should be prescribed and how providers can better help patients manage their health. […] The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have produced an updated consensus statement on how to manage hyperglycaemia (high blood sugar) in patients with type 2 diabetes. […] The new recommendations say type 2 diabetes patients with clinical cardiovascular disease should take a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium-glucose cotransporter 2 (SGLT2) inhibitor. […] There is also more focus on diet, weight loss medications, and weight loss surgery as strategies for diabetes control. […] Metformin continues to be the first-line recommended therapy for almost all patients with type 2 diabetes.

• #70 Individualizing Treatment of Hyperglycemia in Type 2 Diabetes | MDedge

  https://www.mdedge.com/jcomjournal/article/145784/diabetes/individualizing-treatment-hyperglycemia-type-2-diabetes

  This article examines key issues faced by primary care providers when managing hyperglycemia in patients with T2DM and outlines a stepwise approach to determining the optimal antihyperglycemic agent(s). […] Focusing on the most widely used agents today, we discuss current evidence and recommendations around glycemic goal setting and the potential risks and benefits of various pharmacologic treatment options with emphasis on hypoglycemia risk, effects on weight, and cardiovascular outcomes. […] A one-size-fits-all glycemic goal is no longer recommended. […] Personalization is necessary, balancing the potential benefits and risks of treatments required to achieve that goal. […] A particular group in which less stringent goals should be considered is older patients, especially those with complex or poor health status.

• #71 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  Patients with newly diagnosed diabetes should participate in a comprehensive diabetes self-management education program, which includes individualized instruction on nutrition, physical activity, optimizing metabolic control, and preventing complications. […] Medical nutrition therapy (MNT) is the process by which a dietary plan is tailored for people with diabetes, based on medical, lifestyle, and personal factors. […] For patients with type 2 diabetes, body weight management should be considered as a therapeutic target in addition to glycemia. […] Weight loss improves glycemia through mitigation of insulin resistance and impaired beta cell function, two major metabolic perturbations evident in type 2 diabetes. […] Pharmacotherapy targeted solely for weight management is effective in patients with type 2 diabetes.

• #72 Treatment Strategies for Hyperglycemia

  https://www.ajmc.com/view/treatment-strategies-for-hyperglycemia

  The panel shares insights into the evolution of treatment strategies for patients with diabetes. […] When were managing type 2 diabetes, we have to look at managing hyperglycemia. How do you manage hyperglycemia? […] We have therapies that treat hyperglycemia and also reduce the risk for these complications. Remember, its more than lowering glucose. […] If I can reduce their risk for cardiovascular disease with a therapy that also lowers their glucose, thats where Im going to go. The guidelines support that. […] Traditionally, if they have cardiovascular risk, I like to go with a GLP1 receptor agonist. If they have chronic kidney disease or heart failure risk, I like to go with an SGLT2. […] We have better therapies that do more than lower blood sugar. […] Its not just to reduce cardiovascular or kidney risk, its also because these medicines have little to no inherent risk of causing hyperglycemia, and they often provide favorable effects on weight. […] We need to make sure that whatever were recommending is medically appropriate for that individual but also something they can access and tolerate and would be willing to take.

• #73 Treatment Strategies for Hyperglycemia

  https://www.ajmc.com/view/treatment-strategies-for-hyperglycemia

  The panel shares insights into the evolution of treatment strategies for patients with diabetes. […] When were managing type 2 diabetes, we have to look at managing hyperglycemia. How do you manage hyperglycemia? […] We have therapies that treat hyperglycemia and also reduce the risk for these complications. Remember, its more than lowering glucose. […] If I can reduce their risk for cardiovascular disease with a therapy that also lowers their glucose, thats where Im going to go. The guidelines support that. […] Traditionally, if they have cardiovascular risk, I like to go with a GLP1 receptor agonist. If they have chronic kidney disease or heart failure risk, I like to go with an SGLT2. […] We have better therapies that do more than lower blood sugar. […] Its not just to reduce cardiovascular or kidney risk, its also because these medicines have little to no inherent risk of causing hyperglycemia, and they often provide favorable effects on weight. […] We need to make sure that whatever were recommending is medically appropriate for that individual but also something they can access and tolerate and would be willing to take.

• #74 Diabetes Mellitus (DM) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm

  In people with diabetes and obesity, physicians should prescribe antihyperglycemic medications that promote weight loss (eg, GLP1 receptor agonists, SGLT-2 inhibitors, or a dual incretin agonist) or are weight-neutral (eg, dipeptidyl peptidase-4 inhibitors, metformin), if possible. […] Regular professional podiatric care, including trimming of toenails and calluses, is important for patients with sensory loss or circulatory impairment. […] All patients with diabetes mellitus should be vaccinated against Streptococcus pneumoniae, influenza virus, hepatitis B, varicella, and SARS-CoV-2 as per standard recommendations. […] Pancreas transplantation and transplantation of pancreatic islet cells are alternative means of insulin delivery.

• #75 Individualizing Treatment of Hyperglycemia in Type 2 Diabetes | MDedge

  https://www.mdedge.com/jcomjournal/article/145784/diabetes/individualizing-treatment-hyperglycemia-type-2-diabetes

  This article examines key issues faced by primary care providers when managing hyperglycemia in patients with T2DM and outlines a stepwise approach to determining the optimal antihyperglycemic agent(s). […] Focusing on the most widely used agents today, we discuss current evidence and recommendations around glycemic goal setting and the potential risks and benefits of various pharmacologic treatment options with emphasis on hypoglycemia risk, effects on weight, and cardiovascular outcomes. […] A one-size-fits-all glycemic goal is no longer recommended. […] Personalization is necessary, balancing the potential benefits and risks of treatments required to achieve that goal. […] A particular group in which less stringent goals should be considered is older patients, especially those with complex or poor health status.

• #76 Individualizing Treatment of Hyperglycemia in Type 2 Diabetes | MDedge

  https://www.mdedge.com/jcomjournal/article/145784/diabetes/individualizing-treatment-hyperglycemia-type-2-diabetes

  The risk of intensive glycemic control may exceed the benefits in these patients, as they are at higher risk of hypoglycemia and polypharmacy. […] There is strong consensus that metformin is the preferred drug for monotherapy due to its long proven safety record, low cost, weight-reduction benefit, and potential cardiovascular advantages. […] As long as there are no contraindications, metformin should be recommended concurrent with lifestyle intervention at the time of diabetes diagnosis.

• #77

  https://www.jci.org/articles/view/142243

  These recommendations were not followed in practice. […] SGLT2is slowed progression of diabetic kidney disease, with meta-analysis estimating a hazard ratio of 0.62. […] The heart failure and renoprotection benefits were quantitatively larger and more consistently observed than improvement in MACE-3 outcomes. […] While glycemic control is a critical element of therapeutic regimens for T2D, other elements are also important, including lifestyle and cardiovascular medications. […] The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have jointly formulated therapeutic guidelines, which recommend individualizing HbA1c targets based on multiple considerations. […] ADA/EASD guidelines recommend metformin as first-line therapy for HbA1c-lowering in T2D and suggest four principal options for drugs to be added in patients not achieving their therapeutic target: DPP4is, GLP1RAs, SGLT2is, or TZDs. […] This intensive therapeutic strategy offers substantial potential to improve outcomes for T2D patients.

• #78

  https://www.jci.org/articles/view/142243

  Intensive glucose control did not significantly affect risks of macrovascular endpoints. […] Microvascular complications. DCCT and UKPDS demonstrated that enhanced glycemic control slows progression of microvascular complications (retinopathy, nephropathy, and neuropathy). […] Macrovascular complications. Long-term follow up in DCCT/EDIC and UKPDS strongly supports the conclusion that intensive glycemic control can in the fullness of time improve cardiovascular outcomes. […] Twelve classes of drugs are approved to treat T2D: biguanides (e.g., metformin), sulfonylureas, thiazolidinediones (TZDs), DPP4is, SGLT2is, GLP1RAs, insulins, -glucosidase inhibitors, dopaminergic antagonists, bile acid sequestrants, meglitinides, and amylinomimetics. […] The FDA requires sponsors to provide additional cardiovascular safety data: (a) a preapproval analysis to exclude an 80% increase in cardiovascular risk; and (b) a dedicated post-approval trial to exclude a 30% increase in risk.

• #79 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  Although metformin is usually started for the management of hyperglycemia, it is also frequently an effective medication to promote modest weight loss. […] Insulin, rather than oral hypoglycemic agents, is often indicated for initial treatment of symptomatic or severe hyperglycemia. […] Insulin should also be initiated whenever there is a possibility of undiagnosed type 1 diabetes. […] The use of metformin as initial therapy is supported by meta-analyses of trials and observational studies evaluating the effects of oral or injectable diabetes medications as monotherapy on intermediate outcomes (A1C, body weight, lipid profiles) and adverse events. […] Cardiovascular benefit has been demonstrated for selected classes of diabetes medications, usually when added to metformin. […] Our approach is largely consistent with American and European guidelines. […] For patients who are not meeting glycemic targets despite diet, exercise, and metformin, combination therapy is necessary to achieve optimal results.

• #80 Hyperglycemia in diabetes – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/diagnosis-treatment/drc-20373635

  Your health care provider sets your target blood sugar range. For many people who have diabetes, Mayo Clinic generally recommends the following target blood sugar levels before meals: […] For many people who have diabetes, the American Diabetes Association generally recommends the following target blood sugar levels: […] Your target blood sugar range may differ, especially if you’re pregnant or you have other health problems that are caused by diabetes. […] Routine blood sugar monitoring with a blood glucose meter is the best way to be sure that your treatment plan is keeping your blood sugar within your target range. […] If your blood sugar level is 240 mg/dL (13.3 mmol/L) or above, use an over-the-counter urine ketones test kit. […] An A1C level of 7% or less means that your treatment plan is working and that your blood sugar was consistently within a healthy range.

• #81 Hyperglycemia Treatment: Several Options And IV Fluids

  https://diabetesmantra.com/diabetes/treatment/hyperglycemia-treatment/

  A key component in managing hyperglycemia is dietary modification. Carbohydrate counting is crucial, as carbohydrates directly impact blood sugar levels. It involves keeping track of the amount of carbohydrates consumed at each meal and adjusting insulin accordingly. Adopting a balanced diet is equally important. A diet rich in fruits, vegetables, whole grains, and lean proteins, with limited intake of processed foods, refined sugars, and saturated fats, can help maintain stable blood sugar levels. […] Regularly checking blood sugar levels is crucial in managing hyperglycemia. This can be done using a traditional blood glucose meter, which involves pricking the finger to get a blood sample, or through continuous glucose monitoring systems (CGMs) that provide real-time blood sugar readings. Monitoring helps in making informed decisions about diet, exercise, and medication. It also helps in identifying patterns and trends in blood sugar levels. This is vital for long-term diabetes management.

• #82 Hyperglycemia Treatment: Several Options And IV Fluids

  https://diabetesmantra.com/diabetes/treatment/hyperglycemia-treatment/

  A key component in managing hyperglycemia is dietary modification. Carbohydrate counting is crucial, as carbohydrates directly impact blood sugar levels. It involves keeping track of the amount of carbohydrates consumed at each meal and adjusting insulin accordingly. Adopting a balanced diet is equally important. A diet rich in fruits, vegetables, whole grains, and lean proteins, with limited intake of processed foods, refined sugars, and saturated fats, can help maintain stable blood sugar levels. […] Regularly checking blood sugar levels is crucial in managing hyperglycemia. This can be done using a traditional blood glucose meter, which involves pricking the finger to get a blood sample, or through continuous glucose monitoring systems (CGMs) that provide real-time blood sugar readings. Monitoring helps in making informed decisions about diet, exercise, and medication. It also helps in identifying patterns and trends in blood sugar levels. This is vital for long-term diabetes management.

• #83 Hyperglycemia in diabetes – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/diagnosis-treatment/drc-20373635

  If your A1C level is higher than 7%, your blood sugar, on average, was above a healthy range. In this case, your health care provider may recommend a change in your diabetes treatment plan. […] Talk to your health care provider about managing your blood sugar. Understand how different treatments can help keep your glucose levels within your target range. […] If you develop hyperglycemia often, your health care provider may adjust the dosage or timing of your medication. […] Changes to your insulin program or a supplement of short-acting insulin can help control hyperglycemia. […] Emergency treatment can lower your blood sugar to a normal range. […] Treatment usually includes: […] Insulin reverses the processes that cause ketones to build up in your blood. […] If you have trouble keeping your blood sugar within your target range, schedule an appointment to see your health care provider. […] Your health care provider can recognize trends and offer advice on how to prevent hyperglycemia or adjust your medication to treat hyperglycemia.

• #84 Hyperglycemia (High Blood Sugar): Symptoms and Management

  https://www.healthline.com/health/type-2-diabetes/hyperglycemia

  Hyperglycemia refers to high blood sugar levels. Over time, chronic high blood sugar can cause major health complications. […] Regular blood glucose testing is crucial for people with diabetes. This is because many people don’t feel the effects of hyperglycemia. […] Blood sugar levels that are higher than that may indicate unmanaged or undiagnosed diabetes or a need to adjust your diabetes treatment. […] The longer the condition is left untreated, the more severe it may become. Long-term effects of hyperglycemia include: eye disease, kidney disease, cardiovascular disease, neuropathy, or nerve damage. […] Several treatments are available for chronic high blood sugar. […] An important part of managing diabetes is checking your blood glucose levels often, such as before you eat, after you eat, or at bedtime.

• #85 Hyperglycemia Treatment: Several Options And IV Fluids

  https://diabetesmantra.com/diabetes/treatment/hyperglycemia-treatment/

  A key component in managing hyperglycemia is dietary modification. Carbohydrate counting is crucial, as carbohydrates directly impact blood sugar levels. It involves keeping track of the amount of carbohydrates consumed at each meal and adjusting insulin accordingly. Adopting a balanced diet is equally important. A diet rich in fruits, vegetables, whole grains, and lean proteins, with limited intake of processed foods, refined sugars, and saturated fats, can help maintain stable blood sugar levels. […] Regularly checking blood sugar levels is crucial in managing hyperglycemia. This can be done using a traditional blood glucose meter, which involves pricking the finger to get a blood sample, or through continuous glucose monitoring systems (CGMs) that provide real-time blood sugar readings. Monitoring helps in making informed decisions about diet, exercise, and medication. It also helps in identifying patterns and trends in blood sugar levels. This is vital for long-term diabetes management.

• #86 Hyperglycemia (High Blood Glucose) | American Diabetes Association

  https://diabetes.org/living-with-diabetes/treatment-care/hyperglycemia

  Hyperglycemia is the technical term for high blood glucose (blood sugar). High blood glucose happens when the body has too little insulin or when the body can’t use insulin properly. […] Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your glucose sugar levels should be. Checking your blood and then treating high blood glucose early will help you avoid problems associated with hyperglycemia. […] You can often lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do not exercise. […] Cutting down on the amount of food you eat might also help. Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don’t work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.

• #87 Hyperglycemia Treatment: Several Options And IV Fluids

  https://diabetesmantra.com/diabetes/treatment/hyperglycemia-treatment/

  Proper hydration is crucial for maintaining health, and it plays a specific role in managing hyperglycemia. When blood sugar levels are high, the body tries to excrete excess glucose through urine, which can lead to dehydration. Drinking adequate water can aid in this process and help lower blood sugar levels. Its recommended to drink water or other non-caloric beverages and avoid sugary drinks, which can worsen hyperglycemia. Monitoring fluid intake is particularly important during hot weather or when exercising, as these conditions can increase the risk of dehydration. […] Regular visits to a healthcare provider are essential for anyone managing hyperglycemia, especially for those with diabetes. These check-ups should include not only blood sugar monitoring but also screening for complications of diabetes such as neuropathy, nephropathy, retinopathy, and cardiovascular issues. Health professionals can adjust medications, recommend lifestyle changes, and provide guidance on new treatments or management strategies. These visits are also an opportunity to discuss any challenges or concerns regarding diabetes management.

• #88 Hyperglycemia in diabetes – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/diagnosis-treatment/drc-20373635

  If your A1C level is higher than 7%, your blood sugar, on average, was above a healthy range. In this case, your health care provider may recommend a change in your diabetes treatment plan. […] Talk to your health care provider about managing your blood sugar. Understand how different treatments can help keep your glucose levels within your target range. […] If you develop hyperglycemia often, your health care provider may adjust the dosage or timing of your medication. […] Changes to your insulin program or a supplement of short-acting insulin can help control hyperglycemia. […] Emergency treatment can lower your blood sugar to a normal range. […] Treatment usually includes: […] Insulin reverses the processes that cause ketones to build up in your blood. […] If you have trouble keeping your blood sugar within your target range, schedule an appointment to see your health care provider. […] Your health care provider can recognize trends and offer advice on how to prevent hyperglycemia or adjust your medication to treat hyperglycemia.

• #89 Hyperglycemia in diabetes – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/diagnosis-treatment/drc-20373635

  If your A1C level is higher than 7%, your blood sugar, on average, was above a healthy range. In this case, your health care provider may recommend a change in your diabetes treatment plan. […] Talk to your health care provider about managing your blood sugar. Understand how different treatments can help keep your glucose levels within your target range. […] If you develop hyperglycemia often, your health care provider may adjust the dosage or timing of your medication. […] Changes to your insulin program or a supplement of short-acting insulin can help control hyperglycemia. […] Emergency treatment can lower your blood sugar to a normal range. […] Treatment usually includes: […] Insulin reverses the processes that cause ketones to build up in your blood. […] If you have trouble keeping your blood sugar within your target range, schedule an appointment to see your health care provider. […] Your health care provider can recognize trends and offer advice on how to prevent hyperglycemia or adjust your medication to treat hyperglycemia.

• #90 Individualizing Treatment of Hyperglycemia in Type 2 Diabetes | MDedge

  https://www.mdedge.com/jcomjournal/article/145784/diabetes/individualizing-treatment-hyperglycemia-type-2-diabetes

  Due to the progressive nature of T2DM, glycemic control on metformin monotherapy is likely to deteriorate over time, and there is no consensus as to what the second-line agent should be. […] A second agent should be selected based on glycemic goal and potential advantages and disadvantages of each agent for any given patient. […] If the patient progresses to the point where dual therapy does not provide adequate control, either a third non-insulin agent or insulin can be added. […] Although research is increasingly focusing on what the ideal number and sequence of drugs should be when managing T2DM, investigating all possible combinations in diverse patient populations is not feasible. […] Physicians therefore must continue to rely on clinical judgment to determine how to apply trial data to the treatment of individual patients.

• #91 Hyperglycemia in diabetes – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/diagnosis-treatment/drc-20373635

  If your A1C level is higher than 7%, your blood sugar, on average, was above a healthy range. In this case, your health care provider may recommend a change in your diabetes treatment plan. […] Talk to your health care provider about managing your blood sugar. Understand how different treatments can help keep your glucose levels within your target range. […] If you develop hyperglycemia often, your health care provider may adjust the dosage or timing of your medication. […] Changes to your insulin program or a supplement of short-acting insulin can help control hyperglycemia. […] Emergency treatment can lower your blood sugar to a normal range. […] Treatment usually includes: […] Insulin reverses the processes that cause ketones to build up in your blood. […] If you have trouble keeping your blood sugar within your target range, schedule an appointment to see your health care provider. […] Your health care provider can recognize trends and offer advice on how to prevent hyperglycemia or adjust your medication to treat hyperglycemia.

• #92 Hyperglycaemia (Hypers) | High Blood Sugar | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/hypers

  Checking your blood sugar levels regularly can help you know when your blood sugar levels are high. But there are some steps you can take to either prevent a hyper from happening or to bring down your blood sugar levels. […] If you notice that your blood sugar levels are often higher than the target range discussed with your diabetes team, you should speak to them to discuss the options. […] They will review your treatment and provide you with advice on how to get your blood sugar levels back within your target range. This may include increasing your medication dose or changing or adding another medication.

• #93 Hyperglycemia (High Blood Glucose) | American Diabetes Association

  https://diabetes.org/living-with-diabetes/treatment-care/hyperglycemia

  Hyperglycemia is the technical term for high blood glucose (blood sugar). High blood glucose happens when the body has too little insulin or when the body can’t use insulin properly. […] Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your glucose sugar levels should be. Checking your blood and then treating high blood glucose early will help you avoid problems associated with hyperglycemia. […] You can often lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do not exercise. […] Cutting down on the amount of food you eat might also help. Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don’t work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.

• #94 Recommendations for the pharmacologic treatment of hyperglycemia in type 2 diabetes. Consensus document | Nefrología

  https://www.revistanefrologia.com/en-recommendations-for-pharmacologic-treatment-hyperglycemia-articulo-X2013251411051293

  We must not forget that hyperglycaemia is another risk factor in patients with diabetes and that there are other associated risk factors such as dyslipidaemia, high blood pressure, obesity or tobacco smoking. […] After the onset of treatment, or if changes are introduced, it is necessary to assess a series of aspects: metabolic control by the determination of HbA1c and with capillary glucose profiles. […] If the modifications have not been effective at achieving control targets in the first 3-month period, it will be necessary to intensify treatment and do not delay decision-making. […] Nowadays we have a series of drugs for treating diabetes, such as metformin, sulphonylureas, glinides, thiazolidinediones, disaccharidase inhibitors, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists.

• #95 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter13

  In people with type 2 diabetes with A1C 1.5% above the person’s individualized target, antihyperglycemic pharmacotherapy should be added if glycemic targets are not achieved within 3 months of initiating healthy behaviour interventions. […] Insulin should be initiated immediately in individuals with metabolic decompensation and/or symptomatic hyperglycemia. […] In the absence of metabolic decompensation, metformin should be the initial agent of choice in people with newly diagnosed type 2 diabetes, unless contraindicated. […] Dose adjustments and/or additional agents should be instituted to achieve target A1C within 3 to 6 months. […] In people with clinical cardiovascular (CV) disease in whom A1C targets are not achieved with existing pharmacotherapy, an antihyperglycemic agent with demonstrated CV outcome benefit should be added to antihyperglycemic therapy to reduce CV risk.

• #96

  https://www.jci.org/articles/view/142243

  Pharmacotherapy aims to protect against microvascular complications, including blindness, end-stage kidney disease, and amputations. Landmark clinical trials have demonstrated that intensive glycemic control slows progression of microvascular complications (retinopathy, nephropathy, and neuropathy). […] Long-term follow-up has demonstrated that intensive glycemic control also decreases risk of macrovascular disease, albeit rigorous evidence of macrovascular benefit did not emerge for over a decade. […] Some clinical trials with sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP1) receptor agonists reported data demonstrating cardiovascular benefit (decreased risk of major adverse cardiovascular events and hospitalization for heart failure) and slower progression of diabetic kidney disease.

• #97

  https://www.jci.org/articles/view/142243

  Intensive glucose control did not significantly affect risks of macrovascular endpoints. […] Microvascular complications. DCCT and UKPDS demonstrated that enhanced glycemic control slows progression of microvascular complications (retinopathy, nephropathy, and neuropathy). […] Macrovascular complications. Long-term follow up in DCCT/EDIC and UKPDS strongly supports the conclusion that intensive glycemic control can in the fullness of time improve cardiovascular outcomes. […] Twelve classes of drugs are approved to treat T2D: biguanides (e.g., metformin), sulfonylureas, thiazolidinediones (TZDs), DPP4is, SGLT2is, GLP1RAs, insulins, -glucosidase inhibitors, dopaminergic antagonists, bile acid sequestrants, meglitinides, and amylinomimetics. […] The FDA requires sponsors to provide additional cardiovascular safety data: (a) a preapproval analysis to exclude an 80% increase in cardiovascular risk; and (b) a dedicated post-approval trial to exclude a 30% increase in risk.

• #98 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  The care of patients with type 2 diabetes mellitus has been profoundly shaped by the results of the United Kingdom Prospective Diabetes Study (UKPDS). This landmark study confirmed the importance of glycemic control in reducing the risk for microvascular complications and refuted previous data suggesting that treatment with sulfonylureas or insulin increased the risk of macrovascular disease. […] Significant implications of the UKPDS findings include the following: Microvascular complications (predominantly indicated by the need for laser photocoagulation of retinal lesions) are reduced by 25% when mean HbA1c is 7%, compared with 7.9%. […] Glycemic control has minimal effect on macrovascular disease risk; excess macrovascular risk appears to be related to conventional risk factors such as dyslipidemia and hypertension.

• #99 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  The ADA recommends initiation of complications monitoring at the time of diagnosis of diabetes mellitus. […] The role of hypertension in increasing microvascular and macrovascular risk in patients with diabetes mellitus has been confirmed in the UKPDS and Hypertension Optimal Treatment (HOT) trials. […] The ADA’s Standards of Care in Diabetes2023 advised that the target blood pressure for people with diabetes be below 130/80 mm Hg, if it can be safely achieved. […] The ADA recommends that patients with diabetes who are at high risk for cardiovascular events receive primary preventive therapy with low-dose, enteric-coated aspirin.

• #100 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  The ADA recommends initiation of complications monitoring at the time of diagnosis of diabetes mellitus. […] The role of hypertension in increasing microvascular and macrovascular risk in patients with diabetes mellitus has been confirmed in the UKPDS and Hypertension Optimal Treatment (HOT) trials. […] The ADA’s Standards of Care in Diabetes2023 advised that the target blood pressure for people with diabetes be below 130/80 mm Hg, if it can be safely achieved. […] The ADA recommends that patients with diabetes who are at high risk for cardiovascular events receive primary preventive therapy with low-dose, enteric-coated aspirin.

• #101 Diabetes Mellitus (DM) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm

  In people with diabetes and obesity, physicians should prescribe antihyperglycemic medications that promote weight loss (eg, GLP1 receptor agonists, SGLT-2 inhibitors, or a dual incretin agonist) or are weight-neutral (eg, dipeptidyl peptidase-4 inhibitors, metformin), if possible. […] Regular professional podiatric care, including trimming of toenails and calluses, is important for patients with sensory loss or circulatory impairment. […] All patients with diabetes mellitus should be vaccinated against Streptococcus pneumoniae, influenza virus, hepatitis B, varicella, and SARS-CoV-2 as per standard recommendations. […] Pancreas transplantation and transplantation of pancreatic islet cells are alternative means of insulin delivery.

• #102 Hyperglycemia in diabetes – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631

  Keeping blood sugar in a healthy range can help prevent many diabetes-related complications. Long-term complications of hyperglycemia that isn’t treated include: cardiovascular disease, nerve damage (neuropathy), kidney damage (diabetic nephropathy) or kidney failure, damage to the blood vessels of the retina (diabetic retinopathy) that could lead to blindness, feet problems caused by damaged nerves or poor blood flow that can lead to serious skin infections, ulcerations and, in some severe cases, amputation, bone and joint problems, teeth and gum infections. […] If blood sugar rises very high or if high blood sugar levels are not treated, it can lead to two serious conditions. Diabetic ketoacidosis. This condition develops when you don’t have enough insulin in your body. When this happens, glucose can’t enter your cells for energy. Your blood sugar level rises, and your body begins to break down fat for energy.

• #103 Treatment Strategies for Hypoglycemia and Hyperglycemia

  https://www.contemporaryclinic.com/view/treatment-strategies-for-hypoglycemia-and-hyperglycemia

  A random blood glucose test is recommended to determine whether hyperglycemia is present and whether a referral is necessary for further evaluation of this blood glucose elevation. […] For the patient with hyperglycemia and diabetes, steroid treatment should be prescribed only when necessary and often with instructions to contact the endocrinologist or provider responsible for diabetes management. […] Other medications that elevate blood glucose include beta-blockers, thiazide diuretics and statins in higher doses, and some antipsychotics, such as clozapine and olanzapine. […] More frequent blood glucose monitoring with accurate record keeping is important during any illness. […] Glycemic excursions threaten vascular health. […] For the patient with diabetes, heart disease is the number-one reason for death. Therefore, reinforce medication compliance and carbohydrate knowledge.

• #104

  https://www.jci.org/articles/view/142243

  Intensive glucose control did not significantly affect risks of macrovascular endpoints. […] Microvascular complications. DCCT and UKPDS demonstrated that enhanced glycemic control slows progression of microvascular complications (retinopathy, nephropathy, and neuropathy). […] Macrovascular complications. Long-term follow up in DCCT/EDIC and UKPDS strongly supports the conclusion that intensive glycemic control can in the fullness of time improve cardiovascular outcomes. […] Twelve classes of drugs are approved to treat T2D: biguanides (e.g., metformin), sulfonylureas, thiazolidinediones (TZDs), DPP4is, SGLT2is, GLP1RAs, insulins, -glucosidase inhibitors, dopaminergic antagonists, bile acid sequestrants, meglitinides, and amylinomimetics. […] The FDA requires sponsors to provide additional cardiovascular safety data: (a) a preapproval analysis to exclude an 80% increase in cardiovascular risk; and (b) a dedicated post-approval trial to exclude a 30% increase in risk.

• #105 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  The ADA recommends initiation of complications monitoring at the time of diagnosis of diabetes mellitus. […] The role of hypertension in increasing microvascular and macrovascular risk in patients with diabetes mellitus has been confirmed in the UKPDS and Hypertension Optimal Treatment (HOT) trials. […] The ADA’s Standards of Care in Diabetes2023 advised that the target blood pressure for people with diabetes be below 130/80 mm Hg, if it can be safely achieved. […] The ADA recommends that patients with diabetes who are at high risk for cardiovascular events receive primary preventive therapy with low-dose, enteric-coated aspirin.

• #106 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  Glycemic management—Target glycated hemoglobin (A1C) levels in patients with type 2 diabetes should be tailored to the individual, balancing the anticipated reduction in microvascular complications over time with the immediate risks of hypoglycemia and other adverse effects of therapy. […] A reasonable goal of therapy is an A1C value of ≤7 percent (53.0 mmol/mol) for most patients. […] Improved glycemic management lowers the risk of microvascular complications in patients with type 2 diabetes. […] Cardiovascular risk factor management—In addition to glycemic management, vigorous cardiac risk reduction (smoking cessation; blood pressure control; reduction in serum lipids with a statin; diet, exercise, and weight loss or maintenance; and aspirin for those with established atherosclerotic cardiovascular disease [ASCVD] or after shared decision-making) should be a top priority for all patients with type 2 diabetes.

• #107 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  Glycemic management—Target glycated hemoglobin (A1C) levels in patients with type 2 diabetes should be tailored to the individual, balancing the anticipated reduction in microvascular complications over time with the immediate risks of hypoglycemia and other adverse effects of therapy. […] A reasonable goal of therapy is an A1C value of ≤7 percent (53.0 mmol/mol) for most patients. […] Improved glycemic management lowers the risk of microvascular complications in patients with type 2 diabetes. […] Cardiovascular risk factor management—In addition to glycemic management, vigorous cardiac risk reduction (smoking cessation; blood pressure control; reduction in serum lipids with a statin; diet, exercise, and weight loss or maintenance; and aspirin for those with established atherosclerotic cardiovascular disease [ASCVD] or after shared decision-making) should be a top priority for all patients with type 2 diabetes.

• #108 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  The ADA recommends initiation of complications monitoring at the time of diagnosis of diabetes mellitus. […] The role of hypertension in increasing microvascular and macrovascular risk in patients with diabetes mellitus has been confirmed in the UKPDS and Hypertension Optimal Treatment (HOT) trials. […] The ADA’s Standards of Care in Diabetes2023 advised that the target blood pressure for people with diabetes be below 130/80 mm Hg, if it can be safely achieved. […] The ADA recommends that patients with diabetes who are at high risk for cardiovascular events receive primary preventive therapy with low-dose, enteric-coated aspirin.

• #109 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  Although metformin is usually started for the management of hyperglycemia, it is also frequently an effective medication to promote modest weight loss. […] Insulin, rather than oral hypoglycemic agents, is often indicated for initial treatment of symptomatic or severe hyperglycemia. […] Insulin should also be initiated whenever there is a possibility of undiagnosed type 1 diabetes. […] The use of metformin as initial therapy is supported by meta-analyses of trials and observational studies evaluating the effects of oral or injectable diabetes medications as monotherapy on intermediate outcomes (A1C, body weight, lipid profiles) and adverse events. […] Cardiovascular benefit has been demonstrated for selected classes of diabetes medications, usually when added to metformin. […] Our approach is largely consistent with American and European guidelines. […] For patients who are not meeting glycemic targets despite diet, exercise, and metformin, combination therapy is necessary to achieve optimal results.

• #110 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  Glycemic management—Target glycated hemoglobin (A1C) levels in patients with type 2 diabetes should be tailored to the individual, balancing the anticipated reduction in microvascular complications over time with the immediate risks of hypoglycemia and other adverse effects of therapy. […] A reasonable goal of therapy is an A1C value of ≤7 percent (53.0 mmol/mol) for most patients. […] Improved glycemic management lowers the risk of microvascular complications in patients with type 2 diabetes. […] Cardiovascular risk factor management—In addition to glycemic management, vigorous cardiac risk reduction (smoking cessation; blood pressure control; reduction in serum lipids with a statin; diet, exercise, and weight loss or maintenance; and aspirin for those with established atherosclerotic cardiovascular disease [ASCVD] or after shared decision-making) should be a top priority for all patients with type 2 diabetes.

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