Road Maps to Achieve Glycemic Control in Type 2 Diabetes Mellitus

Abstract

The accompanying Diabetes Road Maps were created to provide direction for clinicians in achieving the hemoglobin A1c (A1C) glycemic goals established by the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE). The three Road Maps consist of the following: one for treatment-naïve patients (Fig. 1), one for treated patients not at A1C goal (Fig. 2), and a third focusing on the prevention of diabetes (Fig. 3). The Road Maps feature individualized treatment regimens based on the presenting A1C in treatment-naïve patients or the current A1C in treated patients, and they stress the need to advance therapy if the A1C goal is not met within 3 months. The importance of targeting the treatment of postprandial hyperglycemia in the lower A1C ranges is emphasized. The following should be noted: 1.The evidence base for each of the medications listed in the columns of the Road Maps can be found in the appended bibliography, and the listed resources are annotated with the levels of evidence. Recommendations are based on A1C-lowering data from US Food and Drug Administration (FDA)-approved clinical trials as well as from the large randomized placebo- or comparator-controlled clinical trials published in peer-reviewed journals, and they are consistent with FDA-approved indications. 2.The relative or rank order of the medications listed in the Road Maps is derived from valid comparator trial data that were available. Because of the paucity of such well-designed head-to-head studies, however, the order of medications is provided as a template, is considerably dictated by the preference of the authors, and is based on extensive clinical experience. Therefore, the recommended order of interventions can be categorized primarily as expert opinions of the Diabetes Road Map Task Force. Fig. 2Road map to assist clinicians in achieving glycemic goals (established by the American College of Endocrinology and the American Association of Clinical Endocrinologists) in treated patients with type 2 diabetes not at hemoglobin A1c goal. View Large Image Figure Viewer Fig. 3Road map to assist clinicians in prevention of type 2 diabetes, as recommended by the American College of Endocrinology and the American Association of Clinical Endocrinologists. View Large Image Figure Viewer