[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-563551-105":53,"doc-detail-563551-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","diabetes-tierchart-april-2020-final","Diabetes Tierchart April 2020 Final","","2020 American Diabetes Association guidance recommends metformin as first-line therapy for type 2 diabetes, combined with weight management and physical activity. For patients with established ASVD or at high risk, chronic kidney disease (CKD), or heart failure (HF), SGLT2 inhibitors or GLP-1 receptor agonists with proven efficacy are recommended regardless of A1C. The document also provides a medication tier chart covering oral and injectable drugs, listing expected A1C reduction categories and insurance/coverage tiers and requirements for several plans including BCBSMA, HPHC, Tufts, Tufts Medicare Preferred, and MassHealth.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/diabetes-tierchart-april-2020-final/563551/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/diabetes-tierchart-april-2020-final/563551.png","ImageObject",442,249,{"name":88,"@type":89},"Indoniesian Boy","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-10-12",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is the preferred initial medication for type 2 diabetes in the 2020 ADA guidance?","Question",{"text":109,"@type":110},"Metformin is recommended as the preferred initial treatment for T2DM, alongside weight management and physical activity.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What therapy is recommended for patients with established ASVD or at high risk, CKD, or HF?",{"text":114,"@type":110},"A SGLT2 inhibitor or a GLP-1 receptor agonist with proven efficacy is recommended regardless of A1C, with class selection guided by whether ASCVD, HF, or CKD predominates.",{"name":116,"@type":107,"acceptedAnswer":117},"How does the document organize diabetes medications for coverage comparison?",{"text":118,"@type":110},"It provides a tier chart listing oral and injectable medications by class, including A1C reduction ranges and plan-specific tier placement or coverage requirements for BCBSMA, HPHC, Tufts, Tufts Medicare Preferred, and MassHealth.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},563551,1792084478,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":101,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},962090760608,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","The American Diabetes Association guidelines for 2020, recommend metformin as the preferred initial treatment for type 2 diabetes (T2DM) along with weight management and physical activity. In patients who have established ASVD or at high risk, CKD, or HF, a SGLT2i or GLP-1 receptor with proven efficacy is recommended independent of A1C.  \n• ASCVD dominates:  \no GLP-1RA with proven CVD benefit (dulaglutide, liraglutide, injectable semaglutide) OR  \no SGLT2i with proven CVD benefit (canagliflozin, empagliflozin) if adequate eGFR  \n• HF or CKD dominates:  \no SGLT2i with evidence of reducing HF and/or CKD progression (empagliflozin, canagliflozin, dapagliflozin) if adequate eGFR OR  \no If SGLT2i intolerant/contraindicated or eGFR is inadequate, then GLP-1RA with proven CVD benefit  \nIn individuals without established cardiovascular disease, pharmacological treatment should be patient-centered taking into account side-effects, cost, impact on weight, risk of hypoglycemia, and other patient preferences. For more detailed information regarding ADA recommendations for pharmacological agents to treat T2DM click here.  \nThe following chart is a list of oral and injectable diabetes medications listed by class with their respective A1C reduction and insurance coverage and/or coverage requirements for BCBS, HPHC, Tufts, TMP, and MassHealth.  \n\n| Medications | BCBSMA | HPHC | Tufts | Tufts Medicare Preferred | MassHealth |\n| --- | --- | --- | --- | --- | --- |\n| Biguanides\u003Cbr>A1C reduction: 1-1.5% |  |  |  |  |  |\n| metformin | Tier 1 | Tier 1;2 | Tier 1 | Tier 1 | Covered |\n| Glucoghage (metformin) | NC | NC | NC;Tier 3 | NC | PA |\n| metformin ER | Tier 1;2 | Tier 1;2 | Tier 1 | Tier 1 | Covered |\n| Gluophage XR (metformin extended release) | NC | NC | NC;Tier 3 | NC | PA |\n| metformin solution | - | Tier 1;2 | - | - | PA |\n| Riomet solution | Tier 2;3;4 | Tier 3;4 | Tier 3; (-) | Tier 3 | PA > 13 years (Brand preferred) |\n| Riomet ER solution | - | Tier 3;4 | - | NC | - |\n\n\n| Medications | BCBSMA | HPHC | Tufts | Tufts Medicare Preferred | MassHealth |\n| --- | --- | --- | --- | --- | --- |\n| metformin extended release (modified) | NC | NC | PA\u003Cbr>(Tier 2;3 once approved) | NC | PA |\n| Glumetza (metformin, modified release) | NC | NC | NC | NC | PA |\n| metformin extended release (osmotic) | NC | Premium Formulary: Tier 1;2 Value Formulary: Tier 1;2;3;4 (depends on strength) | PA\u003Cbr>(Tier 3 once approved) | NC | PA |\n| Fortamet (metformin, osmotic release) | NC | NC | NC | NC | PA |\n| Sodium-glucose co-transporter 2 Inhibitors (SGLT2)\u003Cbr>A1C reduction: 0.5-1% |  |  |  |  |  |\n| Jardiance (empagliflozin) | Tier 2;3 (ST) | Tier 2;3 | Tier 2 | Tier 3 | Covered |\n| Invokana (canagliflozin) | Tier 2;3 (ST) | Tier 2;3 | NC | NC | Covered |\n| Farxiga (dapagliflozin) | NC | Tier 3;4 | NC | Tier 3 | Covered |\n| Steglatro (ertugliflozin) * | NC | Tier 3;4 | NC | NC | PA |\n| Glucagon-like Peptide-1 (GLP-1) Receptor Agonists **\u003Cbr>A1C reduction: 1-1.5% |  |  |  |  |  |\n| Trulicity (dulaglutide) | Tier 2;3 (ST) | Tier 2;3 (ST) | Tier 2 | Tier 3 | PA |\n| Ozempic (semaglutide) | NC | Tier 2;3 (ST) | Tier 2 | Tier 3 | PA |\n| Rybelsus (oral semaglutide) | NC | NC | NC | NC | - |\n| Victoza (liraglutide) | NC | Tier 2;3 (ST) | Tier 2 | Tier 3 | PA |\n| Bydureon (exenatide extended release) | Tier 2;3 (ST) | Tier 2;3 (ST) | NC | Tier 3 | Covered |\n| Bydureon BCise | Tier 2;3 (ST) | Tier 2;3 (ST) | NC | Tier 3 | PA |\n| Byetta (exenatide) | Tier 2;3 (ST) | Tier 2;3 (ST) | NC | Tier 4 | Covered\u003Cbr>(Brand preferred) |\n| Adlyxin (lixisenatide) | NC | Premium Formulary: Tier 3;4 (ST)\u003Cbr>Value Formulary: NC | NC | NC | PA |\n\n\n| Medications | BCBSMA | HPHC | Tufts | Tufts Medicare Preferred | MassHealth |\n| --- | --- | --- | --- | --- | --- |\n| Long-acting Insulin/Glucagon-like Peptide-1 (GLP-1) Receptor Agonists\u003Cbr>A1C reduction: 0.5-1% versus insulin alone |  |  |  |  |  |\n| Xultophy (insulin degludec/liraglutide) | NC | PA\u003Cbr>(Tier 3;4 once approved) | NC | NC | PA ","cbCaii30u4n9yZDJ","https://ap.wps.com/l/cbCaii30u4n9yZDJ","pdf",323134,"English","# Treatment recommendations (ADA 2020)\n## First-line therapy for T2DM\n## Recommendations for ASVD/high risk, CKD, or HF\n## Patient-centered pharmacologic decisions without established CVD\n# Oral and injectable medication tier chart\n## Biguanides (metformin)\n## SGLT2 inhibitors\n## GLP-1 receptor agonists\n## Long-acting insulin / GLP-1 receptor agonist combinations\n## DPP-4 inhibitors\n## Sulfonylureas\n## Meglitinides\n## Thiazolidinediones","[{\"question\":\"What is the preferred initial medication for type 2 diabetes in the 2020 ADA guidance?\",\"answer\":\"Metformin is recommended as the preferred initial treatment for T2DM, alongside weight management and physical activity.\"},{\"question\":\"What therapy is recommended for patients with established ASVD or at high risk, CKD, or HF?\",\"answer\":\"A SGLT2 inhibitor or a GLP-1 receptor agonist with proven efficacy is recommended regardless of A1C, with class selection guided by whether ASCVD, HF, or CKD predominates.\"},{\"question\":\"How does the document organize diabetes medications for coverage comparison?\",\"answer\":\"It provides a tier chart listing oral and injectable medications by class, including A1C reduction ranges and plan-specific tier placement or coverage requirements for BCBSMA, HPHC, Tufts, Tufts Medicare Preferred, and MassHealth.\"}]","Diabetes Tierchart April 2020 Final | PDF",1791836438]