Figure 1.

Evidence-based guideline for antihyperglycemic treatment in patients with T2DM (adopted from the German Diabetes Association [Deutsche Diabetes Gesellschaft/DDG] based on the data from the ACCORD, ADVANCE, VADT and UKPDS post-trial).

^aReduce HbA_1c level to ≤6.5% from ≤7% might be advantageous but only when:

– (severe) hypoglycemia is prevented

– weight gain does not occur

– use of multiple glucose-lowering drugs (>2) or additional insulin therapy can be avoided

HbA_1c should be measured every 3 months. Therapy should be intensified if/when the target level is missed. In contrast, pharmacological dechallenge and ‘step back’ can be performed if the individual HbA_1c remains stable over a longer time.