Blood glucose monitoring
“My fingers are like pin cushions from all this testing.”
Consider
- Low hypoglycemia risk agents → less testing or no testing (metformin, SGLT-2i, GLP-1RA, DPP-4i)
Avoid
- High hypoglycemia risk agents → more testing (sulfonylureas and insulin, especially bolus or sliding scale insulin)
Route of administration
“I have a fear of needles.”
Consider
- Oral agents (metformin, SGLT 2i, DPP 4i, TZD)
Avoid
- Injectable agents (most GLP 1RA and insulin)
Pill Burden
“I take way too many medications.”
Consider
- Once daily agents (metformin extended release, GLP 1RA, SGLT 2i, DPP 4i, TZD , basal insulin)
- Once weekly agents (GLP 1RA)
- Deprescribe other diabetes agents
Avoid
- Multiple daily dosing (metformin immediate release, sulfonylurea, bolus, or sliding scale insulin)