Diabetes Treatment Algorithm

Question 1

first line treatment

Answer 1

lifestyle management

Question 2

first line drug

Answer 2

metformin

Question 3

patient with coronary heart disease first line

Answer 3

metformin + GLP-1

Question 4

patient with coronary heart disease second line

Answer 4

metformin + GLP-1 + SGLT2i

Question 5

patient with coronary heart disease who is not on a GLP-1

Answer 5

metformin + DPP4i

Question 6

patient with coronary heart disease third line

Answer 6

metformin + GLP-1 + SGLT2i + basal insulin

Question 7

patient with coronary heart disease fourth line

Answer 7

metformin + GLP-1 + SGLT2i + basal insulin + TZD

Question 8

patient with coronary heart disease fifth line

Answer 8

metformin + GLP-1 + SGLT2i + basal insulin + TZD + sulphonylurea

Question 9

patient with HF or CKD first line

Answer 9

metformin + SGLT2i

Question 10

patient with HF or CKD who can’t tolerate/is contraindicated for SGLT2i

Answer 10

metformin + GLP-1

Question 11

patient with HF or CKD second line

Answer 11

metformin + SGLT2i + GLP-1

Question 12

patient with HF who is not on GLP-1

Answer 12

metformin + SGLT2i + DPP4i (not saxagliptin)

Question 13

patient with HF or CKD third line

Answer 13

metformin + SGLT2i + GLP-1 + basal insulin

Question 14

patient with HF or CKD fourth line

Answer 14

metformin + SGLT2i + GLP-1 + basal insulin + sulphonylurea

Question 15

patient with need to minimise hypoglycaemia first line

Answer 15

metformin

Question 16

patient with need to minimise hypoglycaemia second line

Answer 16

metformin + SGLT2i

Question 17

patient with need to minimise hypoglycaemia third and fourth line

Answer 17

metformin + SGLT2i (+ GLP-1 + DPP4i + TZD in any order, but not GLP-1 and DPP4i at the same time)

Question 18

patient with need to minimise hypoglycaemia fifth line

Answer 18

metformin + SGLT2i + GLP-1 OR DPP4i + TZD + sulphonylurea

Question 19

patient with need to minimise hypoglycaemia seventh line

Answer 19

metformin + SGLT2i + GLP-1 + DPP4i + TZD + sulphonylurea + basal insulin

Question 20

patient with need to maximise weight loss first line

Answer 20

metformin

Question 21

patient with need to maximise weight loss second line

Answer 21

metformin + SGLT2i

Question 22

patient with need to maximise weight loss third line

Answer 22

metformin + SGLT2i + GLP-1

Question 23

patient with need to maximise weight loss who is not on GLP-1

Answer 23

metformin + SGLT2i + DPP4i

Question 24

patient with need to maximise weight loss fourth line

Answer 24

metformin + SGLT2i + GLP-1 + sulphonylurea

Question 25

patient with need to maximise weight loss fifth line

Answer 25

metformin + SGLT2i + GLP-1 + sulphonylurea + TZD

Question 26

patient with need to maximise weight loss sixth line

Answer 26

metformin + SGLT2i + GLP-1 + sulphonylurea + TZD + basal insulin

Question 27

cost is a major issue first line

Answer 27

metformin

Question 28

cost is a major issue second line

Answer 28

metformin + sulphonylurea OR TZD

Question 29

cost is a major issue third line

Answer 29

metformin + sulphonylurea + TZD

Question 30

cost is a major issue fourth line

Answer 30

metformin + sulphonylurea + TZD + basal insulin

Question 31

cost is a major issue fifth line

Answer 31

metformin + sulphonylurea + TZD + basal insulin + DPP4i OR SGLT2i