CLINICAL MANAGEMENT GUIDELINE

Type 2 diabetes mellitus without complication

ICD10: Type 2 diabetes mellitus without complications [E11.9]

Treatment: Glycemic control for HbA1c >10 or FBG >300

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.

TestDiagnostic ResultNote
Random blood glucose(RBG)> 200 mg/dl or 11.1 mmolIt requires a second confirmatory test.
Fast blood glucose (FBG) for 8 hrs> 200 mg/dl or 11.1 mmol
HbA1c≥6.5%

Note: Glycemic control is a patient-centric plan. Physicians should personalize the management plan based on patient preference.

Preconditions
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 regimenAffects medication choice.

Monitoring parameters:

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.

Clinical Goal
HbA1c < 7-10%Achieved through controlling caloric intake, metabolism, and/or prandial insulin regimen.
FBG < 130 mg/dlAchieved through adequate basal insulin coverage. Either through non-insulin or insulin regimen.
Pre prandial BG < 130 mg/dlAchieved through adequate prandial insulin regimen, and caloric control.
Reduce macro and microvascular complicationsAchieved 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.

Note:

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.

Treatments

Level 1 / 2
pharmacological
insulin isophane
ROUTE
SubQ
DOSE
0.100 U
FREQUENCY
BID
pharmacological
Metformin
ROUTE
Oral
DOSE
500.000 mg
FREQUENCY
OD-QID
prevention
Weight reduction regimen
consultation
Weight-reducing diet education

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  • Duplicating mechanism of action of effect
  • Weight based dosing
  • Contraindication
  • Renal dosing
  • Interactions to drugs or diseases
  • Hepatic dosing

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