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Measurements of glycosylated hemoglobin may be especially useful for evaluating long-term control (see also DOSAGE AND ADMINISTRATION).

On the basis of the evidence reviewed in this paper, ACP has found strong evidence that in most patients with type 2 diabetes in whom lifestyle modifications have failed to adequately improve hyperglycemia, oral pharmacologic therapy with metformin (unless contraindicated) is an effective management strategy.

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After the run-in period, patients were randomized to canagliflozin 100 mg, canagliflozin 300 mg, or placebo, administered once daily as add-on to metformin and insulin.

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Abbasi F, Kamath V, Rizvi AA, Carantoni M, Chen YD, Reaven GM: Results of a placebo-controlled study of the metabolic effects of the addition of metformin to sulfonylurea-treated patients: evidence for a central role of adipose tissue.

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There are no data on the best time to add oral therapies to lifestyle modifications; thus, to avoid an unacceptable burden on patients, other complicating factors should be considered, such as life expectancy of the patient, presence or absence of microvascular and macrovascular complications, risk for adverse events related to glucose control, and patient preferences ().

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