Type 2 diabetes: stepped-care approach to patient management.

An oral antidiabetic medication and/or insulin in addition to exercise and a nutritious meal plan form the basis for treatment of type 2 diabetes. Blood glucose self-monitoring helps guide therapeutic decisions. Therapy needs modification when glycated hemoglobin levels exceed 8%. Initially pharmacologic therapy may include any one of the following: a sulfonylurea, metformin, acarbose, troglitazone, or insulin. If monotherapy does not maintain near-normoglycemia, combined oral antidiabetic medication or insulin may bring glucose levels into the therapeutic range. If combination therapy does not achieve target goals, then insulin given twice daily or more often becomes necessary.