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A1C: ≤7.0 %
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FPG: 4.0–7.0 mmol/L
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2-hr PPG: 5.0–10.0 mmol/L
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Management:
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Lifestyle interventions:
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• Initiate nutrition therapy and physical activity; if BG targets not met, initiate pharmacotherapy
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Pharmacotherapy:
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If BG < 15 mmol/L:
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Non-insulin therapies →
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• Metformin
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• Insulin secretagogues
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→ If using once-daily prednisone, use shorter-acting agents (e.g., glyburide, gliclazide, repaglinide) dosed once-daily with prednisone
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→ If using dexamethasone or shorter-acting agents > once/day, use longer-acting agents (e.g., gliclazide MR, glimepiride)
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• DPP-4 inhibitor
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• GLP-1 agonist
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If BG < 15 mmol/L vs. >15 mmol/L
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Insulin
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→ Starting dose: 0.15-0.3 units/kg/day
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→ If using once-daily prednisone in the morning, FPG less affected but BG will be higher later in the day:
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• Initiate intermediate-acting insulin (N or NPH) or a premixed combination of intermediate- and fast-acting insulin, administered in the morning
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• Add evening insulin if FPG is elevated
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→ If using dexamethasone or shorter-acting agents > once/day, BG likely to be affected throughout the entire day:
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• Use intermediate-acting insulin twice daily or long-acting insulin (detemir, glargine)
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• Fast-acting insulin at mealtimes can be used in combination with intermediate- and long-acting insulin
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Metformin
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→ Often recommended in combination with insulin
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Caution: If reducing the GC dose, adjust diabetes medications to avoid hypoglycemia
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