The Canadian Diabetes Association has become Diabetes Canada*
Is this patient newly diagnosed with type 2 diabetes?
Which of the following applies to your patient?
Are glycemic targets now being met?
Does this patient have clinical cardiovascular disease?
What medications is this patient currently taking?
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What is the patient's eGFR?
Start antihyperglycemic agent with demonstrated CV benefit (empagliflozin, liraglutide, canagliflozin)
For empagliflozin and canagliflozin more intensive monitoring of renal function is recommended if eGFR is less than 45.
Start antihyperglycemic agent with demonstrated CV benefit (liraglutide)
Start healthy behaviour interventions; start metformin if glycemic targets not met within 3 months
If targets still not met, start antihyperglycemic agent with demonstrated CV benefit (empagliflozin, liraglutide, canagliflozin)
Start healthy behaviour interventions
If targets still not met, start antihyperglycemic agent with demonstrated CV benefit (liraglutide)
Start healthy behaviour interventions; start metformin immediately; consider starting a second agent concurrently
Consider starting antihyperglycemic agent with demonstrated CV benefit (empagliflozin, liraglutide, canagliflozin)
Start healthy behaviour interventions; consider starting two agents concurrently
Consider starting antihyperglycemic agent with demonstrated CV benefit (liraglutide)
Start healthy behaviour interventions; start insulin immediately (with or without metformin)
If the glycemic target is not reached, add an agent best suited to the individual. See the following table
Please complete step 1
*IMPORTANT* This table has been individualized and some medications may have been removed based on patient characteristics.
Click a column title to sort results by that column.
When sorting table by column, rows with equivalent values are sorted alphabetically. Therefore, the row order of equivalent values does not imply a preference. Up and down arrows (↑↓) indicate approximate relative effectiveness. Two or three arrows do not necessarily imply double or triple the effect.
*CAUTION* alpha glucosidase inhibitor (acarbose) eliminated from treatment plan on basis of low eGFR.
*CAUTION* metformin eliminated from treatment plan on basis of low eGFR.
*CAUTION* SGLT2i eliminated from treatment plan on basis of low eGFR.
*CAUTION* sulfonylreas eliminated from treatment plan on basis of low eGFR.
*CAUTION* TZD eliminated from table. Use of TZD with insulin is contraindicated
*CAUTION* SU eliminated from table. Use of a SU and meglitinide together is contraindicated; SU generally has more glucose lowering but may have more side effects (hypoglycemia)
*CAUTION* Meglitinide eliminated from table. Use of a SU and meglitinide together is contraindicated; SU generally has more glucose lowering but may have more side effects (hypoglycemia)
*CAUTION* GLP1RA eliminated from table. Use of a DPP4-i and a GLP1RA together is contraindicated; GLP1RA generally has more glucose lowering but may have more side effects (GI)
*CAUTION* DPP4-i eliminated from table. Use of a DPP4-i and a GLP1RA together is contraindicated; GLP1RA generally has more glucose lowering but may have more side effects (GI)
*CAUTION* Insulin eliminated from table. Use of TZD with insulin is contraindicated
*CAUTION* SU and meglitinide eliminated from table. Use of a SU or meglitinide when on mealtime insulin is not helpful
Note: Alpha-glucosidase inhibitor (acarbose) eliminated from table because patient is already taking a drug from that class.
Note: DPP4-i eliminated from table because patient is already taking a drug from that class.
Note: GLP1RA eliminated from table because patient is already taking a drug from that class.
Note: Insulin eliminated from table because patient is already taking a drug from that class. You could intensify insulin therapy.
Note: Meglitinide eliminated from table because patient is already taking a drug from that class.
Note: Metformin eliminated from table because patient is already taking a drug from that class.
Note: SU eliminated from table because patient is already taking a drug from that class.
Note: SGLT2i eliminated from table because patient is already taking a drug from that class.
Note: TZD eliminated from table because patient is already taking a drug from that class.
*The Canadian Diabetes Association is the registered owner of the name Diabetes Canada. All content on guidelines.diabetes.ca, CPG Apps and in our online store remains exactly the same. For questions, contact communication@diabetes.ca.