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

  1. David M. Nathan (dnathan{at}partners.org)1,
  2. John B. Buse2,
  3. Mayer B. Davidson3,
  4. Ele Ferrannini4,
  5. Rury R. Holman5,
  6. Robert Sherwin6 and
  7. Bernard Zinman7
  1. From the 1Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts
  2. the2University of North Carolina School of Medicine, Chapel Hill, North Carolina
  3. the3Clinical Center for Research Excellence, Charles R. Drew University, Los Angeles, California
  4. the4Department of Internal Medicine, University of Pisa, Pisa, Italy
  5. the5Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University, Oxford, U.K.
  6. the6Department of Internal Medicine and Endocrinology, Yale University School of Medicine, New Haven, Connecticut; and
  7. the 7Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

    Abstract

    Abstract 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.

    Footnotes