The 2016 American Diabetes Association diabetes guidelines is a lengthy document outlining many aspects of diabetes care including evaluation, diagnosis, prevention, management of glycemia, and management of nonglycemic issues. Here are some of the more common elements that come up in the internal medicine setting regarding glycemic control.
A middle-aged patient with diabetes mellitus type 2, CAD, HTN, and obesity is in clinic for a followup appointment 1 year after his diagnosis with diabetes. His medications include lisinopril, atorvastatin, aspirin, and metformin (started 1 year ago and titrated to maximum tolerated dose). Today in clinic, his BP = 148/88 mm Hg, HR = 78 bpm, and HbA1c = 7.6%. In addition to metformin, are there any other antihyperglycemic medications that we can use to reduce his risk of cardiovascular events? For many years, metformin was the only antihyperglycemic medication proven to reduce mortality in patients with diabetes mellitus type 2 (as per the UKPDS trial). Other classes of medications such as the sulfonylureas, thiazolidinediones, and DPP-4 inhibitors have only been shown to reduce HbA1c and/or microvascular events. This month, the FDA approved
