Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy

A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes

  1. David M. Nathan, MD1,
  2. John B. Buse, MD, PHD2,
  3. Mayer B. Davidson, MD3,
  4. Ele Ferrannini, MD4,
  5. Rury R. Holman, FRCP5,
  6. Robert Sherwin, MD6 and
  7. Bernard Zinman, MD7
  1. 1Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts
  2. 2University of North Carolina School of Medicine, Chapel Hill, North Carolina
  3. 3Clinical Center for Research Excellence, Charles R. Drew University, Los Angeles, California
  4. 4Department of Internal Medicine, University of Pisa, Pisa, Italy
  5. 5Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University, Oxford, U.K.
  6. 6Department of Internal Medicine and Yale Center for Clinical Investigation, Yale University School of Medicine, New Haven, Connecticut
  7. 7Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  1. Corresponding author: David. M. Nathan, dnathan{at}


The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. The authors continue to endorse the principles used to develop the algorithm and its major features. We are sensitive to the risks of changing the algorithm cavalierly or too frequently, without compelling new information. An update to the consensus algorithm published in January 2008 specifically addressed safety issues surrounding the thiazolidinediones. In this revision, we focus on the new classes of medications that now have more clinical data and experience.


  • This article is being simultaneously published in 2009 by Diabetes Care and Diabetologia by the American Diabetes Association and the European Association for the Study of Diabetes.

    An American Diabetes Association consensus statement represents the authors’ collective analysis, evaluation, and opinion at the time of publication and does not represent official association opinion.

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This Article

  1. Diabetes Care vol. 32 no. 1 193-203
  1. All Versions of this Article:
    1. dc08-9025v1
    2. dc08-9025v2
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