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Coordinator:
Prof Dr Zafar Ahmed Latif (BIRDEM)
Members:
Prof Dr Md Faruque Pathan (BIRDEM)
Prof Dr Md Farid Uddin (BSMMU)
Dr S M Ashrafuzzaman (BIRDEM)
Dr Shahjada Selim (BIRDEM)
Management Goal:
Blood glucose Fasting/Premeal < 6 mmol/l
2h- post meal < 8 mmol/l (Breakfast, Lunch or Dinner )
HbA1c < 7 % ( < 8 % for older age)
Blood Lipids CHOL < 200 mg/dl
LDL < 100 mg/dl
TG < 150 mg/dl
HDL > 40 mg/dl
Blood Pressure SBP < 130 mm of Hg
DBP < 80 mm of Hg
Body weight BMI < 23kg/m2 or Waist < 90 cm (Male) and < 80
cm (Female)
Patient Education Diet, Exercise, Monitoring and adjustment of
OAD/insulin, Empowerment
N.B. Less strict control of BG is appropriate for children, old age, repeated hypoglycemia, advanced CKD, CLD, limited
life expectancy etc cases.
Modalities of treatment:
Regimen Item
1 Life style ( Diet+ Exescise)
2 LS± Metformin or other Sensitizer
3 LS± Metformin+ Secretagauge
4 LS+ Insulin ± sensitizer± OAD
5 Other regime(GLP-1, DPP4 i ) ± OAD/Insulin
6 Insulin
LS= Lifestyle OAD= Oral Anti Diabetic Drugs
1
** Guideline for initiation of treatment for uncomplicated and non-pregnant T2DM
Category Blood Glucose Treatment
A FBG<10 mmol/L , RBS <14 mmolL/L Life style ± Metformin
HbA1c < 8%
B FBG 10- 14 mmol/L , RBS 14-17 mmol/L Life style ± Metformin + SU
HbA1c 8 -10% (Sulphonylurea)
C FBG >14 mmol/L, RBS>17 mmol/L Life style + Insulin
HbA1c >10%
N.B. Consider contraindication and side-effect of a drug before selection and also cost
Drugs for diabetes
Oral : Secretagouge (Sulphonylurea): Gliclazide, Glimiperide, Glipizide, Glibanclamide;
Sensitizer: Metformin, Pioglitazone
Injectable: Short acting; Intermediate acting, long acting and Premixed
Type 1 DM and GDM: Start insulin
Who should be tested/ screened for diabetes: (High risk subjects, even asymptomatic)
[Preferably by OGTT]
Age > 35 years
Obesity, Sedentary life style, BMI> 23 kg/m2 (Asian)
Family history of diabetes mellitus or prediabetes
Bad obstetric history /GDM/ Delivery of large baby >4 Kg
Hypertension/ Dyslipidemia/ IHD
PCOS
Chronic illness
2
Diabetes Management Algorithm