Starting Doses for Add-On Therapy in Type 2 Diabetes
The choice of antihyperglycemics used in patients with type 2 diabetes has changed dramatically over the last 5 years. We have an ever increasing number of options that allow us to customize diabetes medications to best fit the needs of the patient.
For the vast majority of individuals with type 2 diabetes, the initial agent should be metformin. This is normally initiated at 500 mg BID for 1 week and increased to the maximum effective dose of 1000 mg BID.
Over-time most patients will require additional antihyperglycemics to meet their glycemic targets. The selection of additional agents should be customized to fit the needs of the patient.
The CDA Guideline Recommendations for Additional Antihyperglycemics
The CDA guideline committee has developed several useful tools to help in the selection of agents to add to metformin monotherapy. These include:
- Management of Hyperglycemia in Type 2 Diabetes Algorithm (2016)
- Antihyperglycemic Agents for Use in Type 2 Diabetes Table (2016)
- Antihyperglycemic Medications and Renal Function (2015)
- Pharmacotherapy for Type 2 Diabetes Interactive Tool (2016)
Each of these tools can provide clinicians with some guidance on which agent to choose for a patient.
Initial Dosing of Antihyperglycemics
This weekend I thought I would develop a quick tool to help clinicians with the normal initiating doses of antihyperglycemics in adults without specific circumstances that will require dose adjustments (e.g. CKD, elderly, etc.). This map contains the “standard” starting doses for each of the different agents from their product monographs (accessed May 2015).
This information is not designed to take the place of the dosing information in the product monographs, but I put this together as a helpful guide to have the normal starting doses all on one page. My goal was to supplement the great information in the CDA guideline tools mentioned above.
Important – This is provided for education purposes only, before initiating any medication the prescriber is strongly encouraged to read the product monograph