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Statement by an American Association of Clinical Endocrinologists/ American College of Endocrinology Consensus Panel on Type 2 Diabetes Mellitus: An Algorithm for Glycemic Control

Rodbard, Helena W., Jellinger, Paul S., Davidson, Jaime A., Einhorn, Daniel, Garber, Alan J., Grunberger, George, Handelsman, Yehuda, Horton, Edward S. +18 more·2009·Endocrine Practice
DOI 10.4158/ep.15.6.540
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Abstract

This report presents an algorithm to assist primary care physicians, endocrinologists, and others in the management of adult, nonpregnant patients with type 2 diabetes mellitus. In order to minimize the risk of diabetes-related complications, the goal of therapy is to achieve a hemoglobin A1c (A1C) of 6.5% or less, with recognition of the need for individualization to minimize the risks of hypoglycemia. We provide therapeutic pathways stratified on the basis of current levels of A1C, whether the patient is receiving treatment or is drug naïve. We consider monotherapy, dual therapy, and triple therapy, including 8 major classes of medications (biguanides, dipeptidyl-peptidase-4 inhibitors, incretin mimetics, thiazolidinediones, alpha-glucosidase inhibitors, sulfonylureas, meglitinides, and bile acid sequestrants) and insulin therapy (basal, premixed, and multiple daily injections), with or without orally administered medications. We prioritize choices of medications according to safety, risk of hypoglycemia, efficacy, simplicity, anticipated degree of patient adherence, and cost of medications. We recommend only combinations of medications approved by the US Food and Drug Administration that provide complementary mechanisms of action. It is essential to monitor therapy with A1C and self-monitoring of blood glucose and to adjust or advance therapy frequently (every 2 to 3 months) if the appropriate goal for each patient has not been achieved. We provide a flow-chart and table summarizing the major considerations. This algorithm represents a consensus of 14 highly experienced clinicians, clinical researchers, practitioners, and academicians and is based on the American Association of Clinical Endocrinologists/American College of Endocrinology Diabetes Guidelines and the recent medical literature.

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  • Current ADA/EASD and AACE/ACE guidelines recommend early initiation of metformin as a first-line drug for monotherapy and combination therapy for patients with type 2 diabetes mellitus.

    “Current guidelines from the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) and the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) recommend early initiation of metformin as a first-line drug for monotherapy and combination therapy for patients with T2DM.”

    From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [17]

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Authors
Rodbard, H. W., Jellinger, P. S., Davidson, J. A., Einhorn, D., Garber, A. J., Grunberger, G., Handelsman, Y., Horton, E. S., Lebovitz, H., Levy, P., Moghissi, E. S., Schwartz, S. S., Bloomgarden, Z. T., Rodbard, H. W., Jellinger, P. S., Davidson, J. A., Einhorn, D., Garber, A. J., Grunberger, G., Handelsman, Y., Horton, E. S., Lebovitz, H., Levy, P., Moghissi, E. S., Schwartz, S. S., & Bloomgarden, Z. T.
Venue
Endocrine Practice
Publisher
Elsevier BV
Published
2009-09
Volume
15
Issue
6
Pages
540-559
ISSN
1530-891X (ISSN-L)
DOI
10.4158/ep.15.6.540
OpenAlex
W2108646121
Cited by
942
References
40
Citations by year
2026: 4 · 2025: 7 · 2024: 7 · 2023: 17 · 2022: 14 · 2021: 14 · 2020: 9 · 2019: 15 · 2018: 20 · 2017: 21 · 2016: 37 · 2015: 39 · 2014: 92 · 2013: 152 · 2012: 164
FWCI
118.13
Type
journal article
Language
en
Update notices
erratum (2009-11-01)
Open access
closed
Licence
Locations
  • Endocrine Practice (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Amylin Pharmaceuticals
  • Novo Nordisk
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes, glycemic control, HbA1c, treatment algorithm, antidiabetic drugs, hypoglycemia risk, insulin therapy, biguanides, DPP-4 inhibitors, incretin mimetics, thiazolidinediones, alpha-glucosidase inhibitors, sulfonylureas, meglitinides, bile acid sequestrants, self-monitoring of blood glucose, drug selection, diabetes management
MeSH terms
Adult, Aged, Algorithms, Blood Glucose, Diabetes Mellitus, Type 2, Drug Therapy, Combination, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Middle Aged, Blood Glucose Self-Monitoring, Risk Assessment, Young Adult

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