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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Summary of glucose-lowering interventions

Summary of glucose-lowering interventions
Intervention Expected decrease in A1C with monotherapy (%) Advantages Disadvantages
Initial therapy
Lifestyle change to decrease weight and increase activity 1 to 2 Broad benefits Insufficient for most within first year owing to inadequate weight loss and weight regain
Metformin 1 to 2 Weight neutral GI side effects, contraindicated with impaired kidney function (eGFR <30 mL/min/1.73 m2)*
Additional therapy
Insulin (usually with a single daily injection of intermediate- or long-acting insulin initially) 1.5 to 3.5 No dose limit, rapidly effective, improved lipid profile 1 to 4 injections daily, monitoring, weight gain, hypoglycemia, analogs are expensive
Dual GLP-1 and GIP receptor agonist (once-weekly injections) 2 to 2.5 Weight loss Requires injection, frequent GI side effects, expensive
Sulfonylurea (shorter-acting agents preferred) 1 to 2 Rapidly effective Weight gain, hypoglycemia (especially with glibenclamide or chlorpropamide)
GLP-1 receptor agonist (oral or daily to weekly injections) 0.5 to 2 Weight loss, reduction in major adverse cardiovascular events (liraglutide, semaglutide, dulaglutide) in patients with established CVD and potentially for those at high risk for CVD Requires injection, frequent GI side effects, expensive
Thiazolidinedione 0.5 to 1.4 Improved lipid profile (pioglitazone), potential decrease in MI (pioglitazone) Fluid retention, HF, weight gain, bone fractures, potential increase in MI (rosiglitazone) and bladder cancer (pioglitazone)
Glinide 0.5 to 1.5Δ Rapidly effective Weight gain, 3 times/day dosing, hypoglycemia
SGLT2 inhibitor 0.5 to 0.7 Weight loss, reduction in systolic blood pressure, reduced cardiovascular mortality in patients with established CVD, improved kidney outcomes in patients with nephropathy Vulvovaginal candidiasis, urinary tract infections, bone fractures, lower limb amputations, DKA
DPP-4 inhibitor 0.5 to 0.8 Weight neutral Possible increased risk of HF with saxagliptin, expensive
Alpha-glucosidase inhibitor 0.5 to 0.8 Weight neutral Frequent GI side effects, 3 times/day dosing
Pramlintide 0.5 to 1 Weight loss 3 injections daily, frequent GI side effects, long-term safety not established, expensive

A1C: glycated hemoglobin; CVD: cardiovascular disease; DKA: diabetic ketoacidosis; DPP-4: dipeptidyl peptidase 4; eGFR: estimated glomerular filtration rate; GI: gastrointestinal; GIP: glucose-dependent insulinotropic polypeptide; GLP-1: glucagon-like peptide-1; HF: heart failure; MI: myocardial infarction; SGLT: sodium-glucose co-transporter 2.

* Initiation is contraindicated with eGFR <30 mL/min/1.73 m2 and not recommended with eGFR 30 to 45 mL/min/1.73 m2.

¶ The order of listing of additional therapies does not indicate a preferred order of selection. The choice of additional therapy should be based on criteria discussed in the UpToDate topics on the management of hyperglycemia in diabetes mellitus.

Δ Repaglinide is more effective in lowering A1C than nateglinide.
Modified with permission from: Nathan DM, Buse JB, Davidson MB, et al. Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009; 32:193-203. Copyright © 2009 American Diabetes Association.
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