🍬 Type 2 Diabetes Glucose-Lowering Pathway (comorbidity-driven drug choice)
This tool selects the preferred glucose-lowering add-on for type 2 diabetes by comorbidity, layering SGLT2 inhibitors and GLP-1 receptor agonists onto metformin per Chinese T2DM guidelines and the ADA.
Type 2 Diabetes Glucose-Lowering Pathway (comorbidity-driven drug choice)
Comorbid ASCVD or high cardiovascular risk
Comorbid heart failure
Comorbid chronic kidney disease (CKD)
eGFR (optional, for SGLT2i applicability) (mL/min/1.73m²)
When to use
Use when escalating T2DM therapy: comorbid heart failure or CKD favors an SGLT2i, ASCVD or high cardiovascular risk favors a GLP-1RA or SGLT2i, and the absence of these favors individualized dual therapy.
How it works
Decision logic: heart failure/CKD → SGLT2i (GLP-1RA if eGFR < 30); ASCVD/high risk → GLP-1RA or SGLT2i regardless of HbA1c; otherwise individualized add-on by hypoglycemia risk, weight, and cost.
Key points
- Cardiorenal-protective agents are chosen for the comorbidity even when HbA1c is at target — the indication is organ protection, not just glucose control. (original synthesis · not guideline verbatim)
- At eGFR < 30 most SGLT2i are off-label, so a GLP-1RA becomes the preferred cardiorenal add-on.
- Metformin and lifestyle remain the foundation unless contraindicated.
References
- Chinese Diabetes Society. Guideline for the Prevention and Treatment of Type 2 Diabetes in China (2020 edition).
- American Diabetes Association. Standards of Care in Diabetes — Pharmacologic Approaches to Glycemic Treatment.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.