The epidemic of type 2 diabetes andthe recognition that achieving specificglycemic goals can substantiallyreduce morbidity have made the effectivetreatment of hyperglycemia a top priority(1–3). While the management of hyperglycemia,the hallmark metabolic abnormalityassociated with type 2 diabetes, hashistorically taken center stage in the treatmentof diabetes, therapies directed atother coincident features, such as dyslipidemia,hypertension, hypercoagulability,obesity, and insulin resistance, havealso been a major focus of research andtherapy. Maintaining glycemic levels asclose to the nondiabetic range as possiblehas been demonstrated to have a powerfulbeneficial effect on diabetes-specific microvascularcomplications, including retinopathy,nephropathy, and neuropathy,in the setting of type 1 diabetes (4,5); intype 2 diabetes, more intensive treatmentstrategies have likewise been demonstratedto reduce microvascular complications(6 – 8). Intensive glycemicmanagement resulting in lower A1C levelshas also been shown to have a beneficialeffect on cardiovascular disease(CVD) complications in type 1 diabetes(9,10); however, current studies havefailed to demonstrate a beneficial effect ofintensive diabetes therapy on CVD in type2 diabetes (11–13).

 

    The development of new classes ofblood glucose–lowering medications tosupplement the older therapies, such aslifestyle-directed interventions, insulin,sulfonylureas, and metformin, has increasedthe number of treatment optionsavailable for type 2 diabetes. Whetherused alone or in combination with otherblood glucose–lowering interventions,the increased number of choices availableto practitioners and patients has heighteneduncertainty regarding the mostappropriate means of treating this widespreaddisease (14). Although numerous reviewson the management of type 2 diabeteshave been published in recent years (15–17), practitioners are often left without aclear pathway of therapy to follow. We developedthe following consensus approachto the management of hyperglycemia in thenonpregnant adult to help guide health careproviders in choosing the most appropriateinterventions for their patients with type 2diabetes.