Initial Management Approach for Newly Diagnosed Diabetes

Initial Assessment and Treatment Algorithm

The American Diabetes Association recommends checking for ketosis/ketoacidosis, random blood glucose levels, and A1C levels to determine diabetes type and severity 1
For patients with A1C ≥8.5% or random blood glucose ≥250 mg/dL with symptoms, or presence of ketosis/ketoacidosis, the American Diabetes Association recommends initiating insulin therapy 1, 3
For metabolically stable patients, the American Diabetes Association recommends metformin as first-line therapy 1
Testing for pancreatic autoantibodies is recommended to differentiate between type 1 and type 2 diabetes 3

The American Diabetes Association recommends starting metformin and titrating up to 2,000 mg per day as tolerated for metabolically stable patients with likely type 2 diabetes 1, 3
For patients requiring insulin, the American Diabetes Association recommends beginning with basal insulin at 0.5 units/kg/day and titrating based on blood glucose monitoring 1
Adding metformin after resolution of ketosis/ketoacidosis is recommended for patients on insulin therapy 1, 3

The American Diabetes Association recommends providing education on healthful nutrition and regular physical activity, with a goal of at least 60 minutes of moderate to vigorous activity daily 1, 5
Setting goals for achieving and maintaining healthy weight is recommended 4

The American Diabetes Association recommends assessing glycemic status every 3 months 1
Targeting A1C <7% for most patients, with more stringent targets for selected individuals, is recommended 1, 5
Individualizing blood glucose monitoring plans based on pharmacologic treatment is recommended 1
Considering continuous glucose monitoring for patients on multiple daily insulin injections is recommended 1

If A1C goals are not met with metformin monotherapy, the American Diabetes Association recommends considering adding GLP-1 receptor agonist or SGLT2 inhibitor for patients with negative pancreatic autoantibodies 1, 3
For patients with positive autoantibodies or unclear diabetes type, titrating or initiating insulin therapy is recommended 3

Establishing an interprofessional diabetes team, including a physician, diabetes care and education specialist, registered dietitian nutritionist, and behavioral health specialist or social worker, is recommended 3, 4

Screening and treating comorbidities, such as microvascular complications, is recommended 3, 4