Individualize the glycemic control goal based on the patient's life expectancy, comorbid conditions, and risk for complications from hypoglycemia.
Target glucose control to achieve an HbA1c level less than 7% in most patients; consider a lower goal in select motivated patients who are low risk for hypoglycemia and a higher goal (8%) in some elderly patients.
Recommend diet and exercise programs as the cornerstones of therapy for diabetes.
Begin oral hypoglycemic agents in patients in whom diet and exercise do not adequately control diabetes, and adjust as needed to achieve the target level of glycemic control. Use metformin as the first-line oral agent in most patients with diabetes.
Consider using a combination of insulin, glucagon-like peptide-1 analogs, and non-insulin agents if non-insulin agents do not achieve the desired level of glycemic control, with individual therapies based on patient preference, side-effect profiles, costs, and patient comorbid conditions.
Treat hypertension preferentially with an ACE inhibitor or ARB, to reduce the risk for adverse microvascular (e.g., retinopathy, nephropathy) and macrovascular (e.g., MI, stroke) outcomes, with a goal blood pressure <140/90 mm Hg.
Treat hyperlipidemia with moderate- or high-intensity statin therapy to reduce the risk for macrovascular complications.
Use aspirin for secondary prevention of cardiovascular disease in patients with diabetes, and consider its use for primary prevention in select patients.
Treat diabetic nephropathy, preferentially with ACE inhibitors, to reduce the risk for progression to end-stage renal failure.
Institute foot-care strategies to prevent ulceration and amputation in patients with documented diabetic neuropathy.
Consider treating painful neuropathy preferentially with pregabalin or tricyclic antidepressants.
Provide pneumococcal vaccination and annual influenza vaccination.
Encourage smoking cessation.