Complete this tool to help assess appropriate pharmacotherapy for type 2 diabetes based on agent and patient characteristics. This tool is intended for health-care providers in selecting glucose lowering therapies when providing care for adults with type 2 diabetes in ambulatory settings. Insulin is recommended for people with symptomatic hyperglycaemia or with metabolic decompensation.
Age:<60 60–80 80+
eGFR:<30 30–45 45–60 >60 I don't know
Urine albumin to creatinine ratio (ACR):<2 2–20 >20 I don't know
What medications is this patient currently taking? (check all that apply)
Enter A1C test results and/or glycemic target (optional):
Do they have atherosclerotic cardiovascular disease (ASCVD) (e.g., history of MI, CVA, PVD, or angina)?Yes No
Do they have a history of heart failure (or evidence of EF < 40)?Yes No
Do they have any risk factors? (check all that apply)smoker hypertension dyslipidemia
If the glycemic target is not reached, add an agent best suited to the individual.
Your patient has ASCVD, add or substitute SGLT2i or GLP1-RA to reduce MACE (Grade A).
Your patient has ASCVD and HF, add or substitute SGLT2i or GLP1-RA to reduce MACE (Grade A).
Your patient has CKD, add or substitute SGLT2i to reduce progression of nephropathy, hospitalization for heart failure (Grade A).
Your patient has CKD, add or substitute GLP1-RA to reduce MACE (Grade B).
Your patient has HF, add or substitute SGLT2i to reduce HHF (Grade A).
Your patient has 2 or more Risk Factors, add or substitute GLP1-RA to reduce MACE. An SGLT2i could be considered to reduce HHF or progression of nephropathy.
Click the toggles to adjust pharmacotherapy table below based on patient priorities
Is avoiding weight gain important?
Is avoiding hypoglycemia important?
Drug classes are listed with priority given to drugs with established cardiorenal benefits, cardiorenal safety, low risks for hypoglycaemia or weight gain.
|Class||Drug||Usual starting dose|
|*see renal dosing if GFR<60|
|GLP1 receptor agonists||Dulaglutide
|Alpha-glucosidase inhibitor||Acarbose||25–50mg tid with meals|
|Insulin||See Insulin Prescription Tool|
*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 email@example.com.