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FIGURE 4. The American Diabetes Association/European Association for the Study of Diabetes Algorithm for Determining Combination Therapy
Figure 4

†Consider initial therapy at this stage when glycated hemoglobin (HbA1C) ≥ 9% (≥ 75 mmol/mol).
‡Consider initial therapy at this stage when blood glucose ≥ 300 to 350 mg/dL (16.7 to 19.4 mmol/L) and/or HbA1C ≥ 10%-12% (86 to 108 mmol/mol), especially if the patient is symptomatic or if catabolic features (eg, weight loss, ketosis) are present, in which case basal insulin + mealtime insulin is the preferred initial regimen.
§Usually a basal insulin (eg, neutral protamine Hagedorn, glargine, detemir).
DPP-4 = dipeptidyl peptidase-4; fxs = fractures; GI = gastrointestinal; GLP-1 = GLP-1 glucagon-like peptide-1; GU = genitourinary; HbA1C = glycated hemoglobin; HF = heart failure; SGLT-2 = sodium-glucose cotransporter-2.   
General recommendations for antihyperglycemic therapy in type 2 diabetes mellitus. Choices of therapy are typically made from top to bottom of the chart, although in some instances, choices may be made horizontally within therapy stages. The order of drug classes in the chart is according to historical availability of the drug class/route of administration and does not indicate any specific preference.
Reproduced with permission by Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140-149.