Fig. 1.

Pharmacologic treatment fOr Adults With Type 2 Diabetes Mellitus (T2dm). This Algorithm Stratifies The Glycemic Control Strategy In Patients With T2dm Based On A1c Levels And Underlying Comorbidities. Self-management Education And Monitoring For Diabetes Should Be Continuously Implemented From The Time Of Diagnosis In All Patients With T2dm. If The A1c Level Is >9.0% And Symptomatic Hyperglycemia Or Metabolic Decompensation Is Present, Insulin Therapy With Or Without Oral Antidiabetic Drugs (Oads) Is Recommended. If Established Atherosclerotic Cardiovascular Disease (Eascvd), Heart Failure (Hf), Or Chronic Kidney Disease (Ckd) Are Combined, Sodium-glucose Cotransporter 2 Inhibitor (Sglt2i) Or Glucagon-like Peptide-1 Receptor Agonist (Glp-1ra), Which Have Proven Benefits Under These Conditions, Are Preferred. If The A1c Difference Between The Current And Target A1c Level Is ≥1.5% Or The Current A1c Level Is ≥7.5%, Initial Combination Therapy Is Recommended. If The Current A1c Level Is <7.5%, Metformin Monotherapy Is The Preferred Option, Depending On The Patient’s Condition. However, Early Combination Therapy Should Be Considered To Reduce The Risk Of Treatment Failure. Injectable Therapy, Glp-1ra Or Insulin Is Recommended When Potent Glucose-lowering Efficacy Is Required. When Considering Injectable-based Combination Therapy, Glp-1ra Is Preferred. If The Glycemic Target Is Not Achieved With Glp-1ra Or Basal Insulin Alone, The Two Drugs Can Be Combined. If The Glycemic Target Is Not Achieved With Glp-1ra Or Basal Insulin, Intensive Insulin Therapy Such As Basal-plus, Premixed, Or Basal-bolus Regimen Should Be Initiated. Tzd, Thiazolidinedione; Dpp-4i, Dipeptidyl Peptidase-4 Inhibitor; Su, Sulfonylurea; Α-gi, Α-glucosidase Inhibitor. ^aEstablished Atherosclerotic Cardiovascular Disease: History Of Acute Coronary Syndrome Or Myocardial Infarction, Stable Or Unstable Angina, Coronary Heart Disease With Or Without Revascularization, Other Arterial Revascularization, Stroke, Or Peripheral Artery Disease Assumed To Be Atherosclerotic In Origin, ^bHf: Current Or Prior Symptoms Of Hf With Documented Hf With Reduced Ejection Fraction (Hfref, Left Ventricular Ejection Fraction [Lvef] ≤40) Or Hf With Preserved Ejection Fraction (Hfpef, Lvef >40), ^cChronic Kidney Disease: Estimated Glomerular Filtration Rate (Egfr) <60 Ml/Min/1.73 M² Or Urine Albumin-creatinine Ratio ≥30 Mg/G, ^dDulaglutide, Liraglutide, Semaglutide, ^eDapagliflozin, Empagliflozin, ^fDapagliflozin, Empagliflozin, Ertugliflozin, ^gPioglitazone.