Comprehensive Management of Type 2 Diabetes

Initial Evaluation and Assessment

A complete medical evaluation should classify diabetes, detect complications, review previous treatment, and establish a baseline for continuing care, according to the American Diabetes Association 1
Laboratory tests should include HbA1c, fasting glucose, lipid profile, kidney function tests, and urine albumin-to-creatinine ratio, as recommended by the American Diabetes Association 1, 2
Assess for presence of comorbidities including obesity, dyslipidemia, hypertension, and existing microvascular complications, as suggested by the American Diabetes Association 1, 2

Diabetes care should be managed by a multidisciplinary team including physicians, nurse practitioners, nurses, dietitians, pharmacists, and mental health professionals, according to the American Diabetes Association 3, 4
Implement a patient-centered communication style that uses person-centered language, active listening, and assesses literacy and potential barriers to care, as recommended by the American Diabetes Association 5, 4
Develop a collaborative relationship with the patient to establish treatment goals and plans based on individual preferences, values, and goals, as suggested by the American Diabetes Association and the American College of Physicians 5, 6

Set individualized HbA1c targets based on patient's age, comorbidities, risk of hypoglycemia, and life expectancy, according to the American Diabetes Association and the American College of Physicians 1, 6
Implement self-monitoring of blood glucose (SMBG) appropriate to medication regimen, as recommended by the American Diabetes Association 1
Regular HbA1c testing (typically every 3-6 months) to assess long-term glycemic control, as suggested by the American Diabetes Association 1

Implement medical nutrition therapy with individualized meal planning, according to the American Diabetes Association 1, 7
For overweight/obese patients, prescribe high-intensity diet, physical activity, and behavioral therapy designed to achieve and maintain ≥5% weight loss, as recommended by the American Diabetes Association 7
Recommend 500-750 kcal/day energy deficit to promote weight loss, according to the American Diabetes Association 7
Provide diabetes self-management education (DSME) and ongoing support as integral components of care, as suggested by the American Diabetes Association 1, 5

Initiate pharmacologic therapy at diagnosis of type 2 diabetes, in addition to lifestyle therapy, according to the American Diabetes Association 8
For metabolically stable patients (HbA1c <8.5% and asymptomatic), metformin is the initial treatment of choice if renal function is adequate (>30 ml/min/1.73 m²), as recommended by the American Diabetes Association 8
For patients with marked hyperglycemia (blood glucose ≥250 mg/dL, HbA1c ≥8.5%) who are symptomatic, initiate basal insulin while starting metformin, according to the American Diabetes Association 8

Regular screening for microvascular complications, including annual comprehensive eye examination, annual screening for diabetic kidney disease, and annual comprehensive foot examination, as recommended by the American Diabetes Association 1
Screen for and treat modifiable cardiovascular risk factors, according to the American Diabetes Association 1
Provide all age-appropriate vaccinations, which are especially important for people with diabetes, as suggested by the American Diabetes Association 5

Regular follow-up visits to assess glycemic control, medication effectiveness and side effects, and progression of complications, according to the American Diabetes Association 1, 5
Adjust treatment plan based on clinical outcomes, patient preferences, and development of complications, as recommended by the American Diabetes Association and the American College of Physicians 5, 6
Implement long-term weight maintenance programs for patients who achieve short-term weight loss goals, according to the American Diabetes Association 7

Understand that patient adherence to complex regimens may be challenging; simplify when possible and address barriers to care, as suggested by the American Diabetes Association and the American College of Physicians 5, 6
Consider social determinants of health that may impact a patient's ability to follow treatment recommendations, according to the American Diabetes Association 5, 4