ACP guidance for treating type 2 diabetes with oral agents

A pen ticking off a checklist

The American College of Physicians has issued updated guidance on managing type 2 diabetes with oral antidiabetic drugs (OADs).

The guideline includes a systematic review of the evidence on efficacy regarding various comparisons of monotherapy and combined therapy.


Key recommendations:

  1. ACP recommends that clinicians add oral pharmacologic therapy in patients diagnosed with type 2 diabetes when lifestyle modifications, including diet, exercise, and weight loss, have failed to adequately improve hyperglycemia.
  2. ACP recommends that clinicians prescribe monotherapy with metformin for initial pharmacologic therapy to treat most patients with type 2 diabetes.
  3. ACP recommends that clinicians add a second agent to metformin to treat patients with persistent hyperglycemia when lifestyle modifications and monotherapy with metformin fail to control hyperglycemia.

Appraisal hints:

  • Does this guidance conform to AGREE principles?  Although the publication reports a systematic search for evidence, other key aspects of the guideline development process are not described.


Qaseem A, Humphrey LL et al.  Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice
guideline from the American College of Physicians
. Ann Intern Med. 2012 Feb 7;156(3):218-31. 22312141

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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