Drug treatment of type 2 diabetes: new guidance from the American College of Physicians

Some pills

This new publication provides guidance for clinicians on the comparative effectiveness and safety of type 2 diabetes medications.

The guidance applies to adults over 18 years of age and does not cover combinations of more than two drugs.

Main recommendations:

  1. The 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 (Grade: strong recommendation; high-quality evidence).
  2. The ACP recommends that clinicians prescribe monotherapy with metformin for initial pharmacologic therapy to treat most patients with type 2 diabetes (Grade: strong recommendation; high-quality evidence).
  3. The 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 (Grade: strong recommendation; high-quality evidence).

Appraisal hints:

Users of this guidance should consider:

  • Conformance with AGREE principles of guideline development
  • Applicability of the guidance in your setting.


The guidance is available full text from the Annals of Internal Medicine.

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;156:218-231.

Share this post: Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+ Share via email


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.

More posts - Website

Follow me here –