Fig. 3.

Treatment algorithm 3 (injectable therapy) for patients with type 2 diabetes mellitus (T2DM). If the glycosylated hemoglobin (A1C) level is >9.0% and symptomatic hyperglycemia or metabolic decompensation is present, insulin therapy can be initiated with or without oral anti-diabetic drug (OAD) in patients with T2DM. Injectable therapy (glucagon-like peptide-1 receptor agonist [GLP-1RA] or insulin) is recommended when potent glucose-lowering efficacy is required. The addition of GLP-1RA, basal insulin, or premixed insulin is recommended equally. If A1C target is not achieved with GLP-1RA or basal insulin-based therapy, free or fixed-ratio combination therapy of GLP-1RA and basal insulin could be considered. Intensification of insulin therapy with premixed insulin twice daily, basal-plus, or basal-bolus is also recommended to enhance blood glucose control.