Use patient characteristics and preferences to set treatment goals, generally with a goal HbA1c <7%.
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 target level of glycemic control. Use metformin as the first-line oral agent in most patients with diabetes.
Consider using a combination of insulin and oral agents if oral agents do not achieve the desired level of glycemic control.
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.
Prevent and treat diabetic nephropathy, preferentially with ACE inhibitors, to reduce the risk for progression to end-stage renal failure in patients with type 2 diabetes.
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.