Ten steps to get more patients with type 2 diabetes to glycaemic goal

1. Aim for good lycaemic control, defined as HbA1c<6.5%

2. Monitor HbA1c every 3 months in addition to regular glucose self monitoring.

3. Aggressively manage hyperglycaemia , dyslipidaemia, and hypertension with teh same intensity to obtain the best patient outcome.

4. Refer all newly diagnosed patients to a unit specialising in diabetes care where possible.

5. Address the underlying pathophysiology, including the treatment of insulin resistance.

6. Treat patients intensively so as to achieve target HbA1c <6.5% within 6 months of diagnosis.

7. After 3 months, if patients are not at target HbA1c <6.5%, consider combinition therapy.

8. Initiate combination therapy, or insulin immediately for all patients with HbA1c >9% at diagnosis.

9. Use combinations of oral anti diabetic agents with complementary mechanisms of action.

10. Implement a multi- and interdisciplinary team approach to diabetes management to encourage patient education, and self care and share respobsibility for patients achieving glucose goals.



Reference:
S. Del Prato, A.M. Felton, M. Munro, R. Nesto, P. Zimmet, B. Zinman. Improving glucose management: Ten steps to get more patients with type 2 diabetes to glycaemic goal. int J clin Pract, November 2005, 59, 11, 1345-1355.