Diabetes is a chronic disease requiring continuous multidisciplinary management strategies. It depends primarily on patient self-management and clinical support for acute or chronic critical hypo- or hyperglycemic complications.
|Random blood glucose(RBG)||> 200 mg/dl or 11.1 mmol||It requires a second confirmatory test.|
|Fast blood glucose (FBG) for 8 hrs||> 200 mg/dl or 11.1 mmol|
Note: Glycemic control is a patient-centric plan. Physicians should personalize the management plan based on patient preference.
|Caloric intake.||Affects the medications dosage.|
|Metabolism rate.||Affects the medications dosage.|
|Financial/insurance coverage.||Affects medication choice.|
|Medication/plan compliance.||Affects medication choice and the dosage.|
|The patient lifestyle.||Affects medication choice and the dosage.|
|Drug interactions.||Affects medication choice.|
|Comorbidities.||Affects medication choice.|
|Acceptable side effects.||Affects medication choice and the dosages.|
|Oral pharmacology vs Insulin regimen||Affects medication choice.|
Hb A1c reduction:
Controlled by increase basal insulin dose, prandial insulin, and caloric intake.
Pre-prandial blood glucose < 130 mg/dL:
Controlled by increasing prandial insulin.
Fast blood glucose < 130 mg/dL:
Controlled by adequate basal insulin coverage; insulin or oral hypoglycemic agents.
|HbA1c < 7-10%||Achieved through controlling caloric intake, metabolism, and/or prandial insulin regimen.|
|FBG < 130 mg/dl||Achieved through adequate basal insulin coverage. Either through non-insulin or insulin regimen.|
|Pre prandial BG < 130 mg/dl||Achieved through adequate prandial insulin regimen, and caloric control.|
|Reduce macro and microvascular complications||Achieved through HbA1c < 7-10%|
|Reduce the risk of hypoglycemia & nocturnal hypoglycemia.||Achieved through appropriate medication choices, dosages, and patient education.|
|Patient satisfaction and good mental health.||Achieved through adequate and open conversation with the patient; about his needs, goals, and lifestyle.|
★ represents the medication's level of effectiveness on HbA1c, in comparison to other agents.
$ represents the medication's average cost in comparison to other diabetic agents.