A1C: glycated hemoglobin (hemoglobin A1C); eGFR: estimated glomerular filtration rate; GLP-1 RA: glucagon-like peptide 1 receptor agonist; MEN: multiple endocrine neoplasia; ASCVD: atherosclerotic cardiovascular disease; GI: gastrointestinal; SGLT2: sodium-glucose co-transporter 2; GAD: glutamic acid decarboxylase; IA-2: tyrosine phosphatase 2.
* Insulin or a GLP-1 RA are the suggested second-line medications as they have been shown to have the best glycemic efficacy. We do not typically use an SGLT2 inhibitor in this setting, due to inferior glycemic efficacy and the potential for increasing symptoms from polyuria.
¶ When the diagnosis of type 1 or type 2 diabetes is uncertain, obtain islet autoantibodies (eg, GAD-65, IA-2). The presence of 1 or more antibodies is consistent with type 1 diabetes. Refer to UpToDate content related to differentiating type 1 and type 2 diabetes.
Δ Consider possibility of undiagnosed type 1 diabetes¶.
◊ GLP-1 RAs with evidence of cardiorenal benefit include dulaglutide, liraglutide, and subcutaneous semaglutide. Exclude contraindications and precautions prior to use (inset box). Refer to UpToDate content for additional information about GLP-1 RAs.