From the Guidelines
The management plan for a patient with Type 2 Diabetes Mellitus (T2DM) should include both medication therapy and a multidisciplinary approach involving allied healthcare providers, with metformin as the first-line medication, starting at 500mg daily with meals and gradually increasing to 1000mg twice daily as tolerated, and referral to a registered dietitian, certified diabetes educator, physical therapist, ophthalmologist, and podiatrist as necessary. The medication plan and medication-taking behavior should be reevaluated at regular intervals (e.g., every 3–6 months) and adjusted as needed to incorporate specific factors that impact choice of treatment 1. For patients not reaching glycemic targets with metformin alone, adding a second agent such as an SGLT-2 inhibitor (like empagliflozin 10-25mg daily) or a GLP-1 receptor agonist (like semaglutide 0.25mg weekly, titrating up to 1mg weekly) is recommended, particularly for patients with established cardiovascular disease. Insulin therapy may be necessary for patients with severely elevated blood glucose levels, typically starting with basal insulin (like glargine 10 units at bedtime, titrating by 2 units every 3 days until fasting glucose reaches target).
Key Components of the Management Plan
- Medication therapy: metformin as first-line, with potential addition of SGLT-2 inhibitors or GLP-1 receptor agonists
- Referral to allied healthcare providers:
- Registered dietitian for medical nutrition therapy
- Certified diabetes educator for education on glucose monitoring, medication management, and lifestyle modifications
- Physical therapist for development of appropriate exercise programs
- Ophthalmologist for regular eye examinations to screen for retinopathy
- Podiatrist for foot care education and early detection of complications
- Regular reevaluation of medication plan and medication-taking behavior
- Consideration of patient-centered factors, such as comorbidities, patient preferences, and priorities, in treatment decisions 1
Importance of Multidisciplinary Approach
A multidisciplinary approach is essential in the management of T2DM, as it provides patients with the necessary support and education to effectively self-manage their condition and prevent complications. This approach should involve a collaborative team of healthcare providers, including physicians, nurses, dietitians, pharmacists, and mental health professionals, working together to develop an individualized treatment plan that addresses the patient's unique needs and goals 1.
Lifestyle Modifications
Lifestyle modifications, such as diet and exercise, are also crucial in the management of T2DM. Patients should be encouraged to adopt a healthy diet and engage in regular physical activity, such as walking or other aerobic exercises, to help improve glycemic control and reduce the risk of complications 1.
Monitoring and Follow-up
Regular monitoring and follow-up are essential in the management of T2DM, to ensure that patients are meeting their treatment goals and to make adjustments to the treatment plan as needed. This should include regular measurements of blood glucose, blood pressure, and lipid profiles, as well as regular foot exams and eye exams to screen for complications 1.
From the FDA Drug Label
Metformin hydrochloride tablets help control your blood sugar in a number of ways. These include helping your body respond better to the insulin it makes naturally, decreasing the amount of sugar your liver makes, and decreasing the amount of sugar your intestines absorb. The management plan for a patient with Type 2 Diabetes Mellitus (T2DM) includes:
- Medication: Metformin hydrochloride tablets to help control blood sugar levels
- Lifestyle modifications:
- Diet: Stay on a prescribed diet
- Exercise: Follow a prescribed exercise program
- Monitoring:
- Regular blood tests to check blood sugar levels and hemoglobin A1C
- Check blood sugar as prescribed by the healthcare provider
- Referral to allied healthcare providers:
- Dietitian: For personalized dietary advice and meal planning
- Exercise physiologist: To develop a safe and effective exercise program
- Diabetes educator: To provide education on diabetes management and self-care
- Podiatrist: For foot care and prevention of diabetes-related foot complications
- Ophthalmologist: For regular eye exams to monitor for diabetes-related eye complications 2
From the Research
Chronic Condition Management Plan for T2DM
The management plan for a patient with Type 2 Diabetes Mellitus (T2DM) includes medication and referral to allied healthcare providers.
- Medication: Metformin is a first-line pharmacological treatment for patients with T2DM due to its favorable overall profile, including its glucose-lowering ability, weight-neutral effects, and low risk of hypoglycemia 3, 4, 5.
- Referral to allied healthcare providers:
- Dietitian: to provide personalized dietary advice and help the patient achieve a healthy weight and improve glycemic control.
- Exercise physiologist: to develop a safe and effective exercise plan to improve insulin sensitivity and overall health.
- Podiatrist: to assess and manage foot health, as patients with T2DM are at risk of developing foot complications.
- Psychologist: to provide support and counseling to help the patient cope with the emotional and psychological aspects of living with a chronic condition.
Medication Management
- Metformin is available in immediate-release and extended-release formulations. The extended-release formulation improves gastrointestinal tolerability, allows once-daily dosing, and is as effective as immediate-release metformin in achieving glycemic control 3, 6.
- The dosage of metformin should be started at a low dose and gradually increased to minimize gastrointestinal side effects 7.
- Patients should be monitored regularly for signs of hypoglycemia, kidney function, and vitamin B12 deficiency, as metformin can increase the risk of these conditions.
Allied Health Referrals
- Regular referrals to allied healthcare providers can help improve patient outcomes and reduce the risk of complications associated with T2DM.
- A multidisciplinary approach to care, including medication management, lifestyle modifications, and regular monitoring, can help patients with T2DM achieve optimal glycemic control and improve their overall health 4, 5.