Part B: Clinical Practice Guideline for Metformin Use in T2DM Guideline: American Diabetes Association (ADA). (2023). Standards of Medical Care in Diabetes.

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Part B: Clinical Practice Guideline for Metformin Use in T2DM

Guideline:

American Diabetes Association (ADA). (2023). Standards of Medical Care in Diabetes.
Source: https://diabetes.org

Summary:

  • Level of Treatment:
    • Metformin is recommended as first-line therapy for T2DM, unless contraindicated.
    • It is also recommended for use in prediabetes to delay progression to T2DM.
  • Level of Evidence:
    • Level A: Strong evidence from well-conducted RCTs.
  • Key Recommendations:
    1. Initiation: Start metformin at diagnosis of T2DM, along with lifestyle modifications.
    2. Dosing: Begin with 500 mg once or twice daily, titrating to a maximum of 2000 mg/day.
    3. Monitoring:
      • Monitor renal function (eGFR) annually.
      • Check vitamin B12 levels periodically in long-term users.
    4. Contraindications: Avoid in patients with eGFR < 30 mL/min or those at risk of lactic acidosis.
    5. Combination Therapy: Metformin can be combined with other agents (e.g., SGLT2 inhibitors, GLP-1 receptor agonists) if glycemic targets are not met.
  • Considerations:
    • Metformin is cost-effective and has a well-established safety profile.
    • It is particularly beneficial for patients with obesity or insulin resistance.

References

  1. Lingvay, I., Manghi, F. P., García-Hernández, P., et al. (2019). “Effect of insulin glargine up-titration vs. metformin addition on glycemic control in patients with uncontrolled type 2 diabetes on metformin monotherapy: The TULIP study.” Diabetes Care, 42(5), 852–860. https://doi.org/10.2337/dc18-2171
  2. Zinman, B., Wanner, C., Lachin, J. M., et al. (2019). “Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes.” New England Journal of Medicine, 373(22), 2117–2128. https://doi.org/10.1056/NEJMoa1504720
  3. American Diabetes Association. (2023). Standards of Medical Care in Diabetes. Retrieved from https://diabetes.org

Presentation Notes:

  • Use bullet points on slides and elaborate during the voice-over.
  • Include visuals such as graphs from the studies or a flowchart from the ADA guidelines.
  • Keep the presentation concise and focused, aiming for 10–15 minutes.

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