Fast Five Quiz: Type 2 Diabetes Key Aspects

Romesh Khardori, MD, PhD

Disclosures

August 18, 2020

According to guidelines from NICE, standard-release metformin is the initial drug treatment for adults with T2D. The dose should be gradually increased over several weeks to minimize the risk for gastrointestinal side effects. The dose of metformin should be reviewed if the eGFR is < 45 mL/min/1.73 m2. If the eGFR drops below 30 mL/min/1.73 m2, metformin should be stopped. The guidelines also recommend caution for persons at risk for sudden deterioration in kidney function and those at risk for eGFR falling below 45 mL/min/1.73 m2.

The NICE guidelines also suggest that pioglitazone should not be offered to or continued in adults with T2D if they have any of the following:

  • Heart failure or history of heart failure

  • Hepatic impairment

  • Diabetic ketoacidosis

  • Current, or a history of, bladder cancer

  • Uninvestigated macroscopic hematuria

In adults with T2D, if initial drug treatment with metformin has not continued to control A1c to below the person's individually agreed threshold for intensification, NICE recommends considering dual therapy with the following:

  • Metformin and a DPP-4 inhibitor or

  • Metformin and pioglitazone or

  • Metformin and a sulfonylurea

In adults with T2D, if metformin is contraindicated or not tolerated and initial drug treatment has not continued to control A1c to below the person's individually agreed threshold for intensification, NICE recommends dual therapy with the following:

  • A DPP-4 inhibitor and pioglitazone or

  • A DPP-4 inhibitor and a sulfonylurea or

  • Pioglitazone and a sulfonylurea

Read more about the treatment of T2D.

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Type 2 Diabetes Mellitus.

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