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MANAGEMENT OF T2DM

Recommendation from ADA Standards of Care in Diabetes - 2024

Select therapies with adequate efficacy to achieve and maintain treatment goals (Glycemic, Weight, and CV risk reduction)

Summary
Glycemic Efficacy Hypoglycemia Weight loss Effect on MACE
Star GLP-1 RA High - Very high No Intermediate to very high Benefit
Metformin High No Neutral Potential benefit
SGLT2-i Intermediate - High No Intermediate Benefit
DPP-4i Intermediate No Neutral Neutral
SU High Yes Gain Neutral
Insulin High – Very high Yes Gain Neutral
Star
Glycemic Management

Very high
glucose-lowering efficacy

Arrow

Semaglutide, Dulaglutide (high dose), Tirzepatide, insulin, combination oral, combination injectable (GLP-1 RA / Insulin)

High glucose-
lowering
efficacy

Arrow

GLP-1 RA (not listed previously), Metformin, SGLT2i, Sulfonylurea, TZD

Intermediate
glucose-lowering efficacy

Arrow

DPP-4i

Remember: Avoidance of hypoglycaemia should be a priority in high-risk individuals.

Star
Weight-Management

Very high
weight-lowering efficacy

Arrow

Semaglutide, Tirzepatide

High weight-
lowering efficacy

Arrow

Dulaglutide, Liraglutide

Intermediate
weight-lowering efficacy

Arrow

GLP-1 RA (not listed previously), SGLT2i

No effect
on weight

Arrow

DPP-4i, Metformin

Consider regimen with high to very high dual glucose and weight lowering efficacy

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