16/05/2025
https://www.facebook.com/share/p/18ygqLUeoz/?mibextid=wwXIfr
Type 2 Diabetes management
Treatment
The first step in managing Type 2 is to initiate treatment with . If necessary, SGLT2i can be added, particularly for patients with chronic heart failure or established disease (CVD) and a high QRISK score (>10%).
Treatments
If Metformin is or not , alternative treatments can be considered, including DPP4i, , SU, and SGLT2i.
If monotherapy is not effective, combination therapy can be initiated. The preferred combinations include:
- Metformin + DPP4i, Pioglitazone, or
- Metformin + SGLT2i + DPP4i, Pioglitazone, or Sulfonylurea (triple therapy)
The treatment preferences based on specific characteristics, such as:
- CVD/HF/High Risk CVD/CKD: SGLT2i
- Weight concerns: GLP-1
- : SU
# # Triple Not Effective
If triple therapy is not effective, consider switching one out for a GLP-1 receptor agonist, particularly for patients with a BMI >35 or those who would benefit from weight loss.
Insulin therapy can be initiated when necessary, with options including:
- Insulin (OD or BD) as first-line treatment
- Isophane + Short Acting (Mixed) if >75mmol/mol
- Detemir/Glargine if assistance is needed (carers)
Targets
The HbA1c targets for different patient groups, including:
- Diet: 48mmol/mol
- Metformin/Single drug not associated with hypos: 48mmol/mol
- Drug treatment associated with hypos: 53mmol/mol
- Step up in treatment when HbA1c: 58mmol/mol
Risk Reduction
The guidance on CVD risk reduction, including:
- QRISK >10%: Atorvastatin 20mg
- (No CKD):
