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

Test|Diagnostic Result|Note
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%

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.

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.

Level 1 is a monotherapy. Level 2 is dual-combined therapy. Level 3 is triple-combined therapy.

Monitoring parameters:

If the set of recommendations failed to reduce FBG <130 mg/dl and/or HbA1c in 3 months, go to the next level

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:

☆ is the level of effectiveness on HbA1c, in comparison to other agents.

$ is the average cost representation in comparison to other agents.

Treatments

Level 1 / 3
pharmacological
Metformin
ROUTE
Oral
DOSE
0.500 g
FREQUENCY
OD
prevention
Aerobic exercises
prevention
Weight reduction regimen
prevention
Smoking cessation therapy
prevention
Alcohol reduction program
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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