Choice of Glucose-lowering Therapy— A Metabolic Fulcrum-based Approach

Abstract

Choosing the appropriate glucose-lowering therapy for the optimal management of type 2 diabetes is always challenging. Existing guidelines either do not offer any recommendations as to which particular drug to use as second- or third-line therapy, or make the issue too confusing for a primary care physician to follow. We suggest a simple, metabolic fulcrum-based approach, which classifies persons with type 2 diabetes as being eubolic, as being predominantly catabolic, or as having “maladaptive anabolism.” This metabolic triage, performed using phenotypic features, with or without supporting investigations, allows the rational choice of therapy, which helps achieve glycemic targets in a more efficient manner.