Essay Diabetes Type 2
If triple therapy with metformin and two other oral drugs is not effective, is not tolerated or is contra-indicated, consider combination therapy with metformin, a sulfonylurea and a GLP-1 mimetic for adults with type 2 diabetes who: In adults with type 2 diabetes, if metformin is contra-indicated or not tolerated, and if dual therapy with two oral drugs has not continued to control Hb A1c to below the person's individually agreed threshold for intensification, consider insulin-based treatment.
Only offer a GLP-1 mimetic in combination with insulin with specialist care advice and ongoing support from a consultant-led multidisciplinary team.
They are written by UK doctors and based on research evidence, UK and European Guidelines.If metformin is contra-indicated or not tolerated, consider initial drug treatment with a dipeptidyl peptidase-4 (DPP-4) inhibitor or pioglitazone or a sulfonylurea.If initial drug treatment with metformin has not continued to control Hb A1c to below the person's individually agreed threshold for intensification, consider dual therapy with metformin combined with one of a DPP-4 inhibitor, pioglitazone or a sulfonylurea.Review the continued need for other blood glucose-lowering therapies.Start insulin therapy for adults with type 2 diabetes from a choice of a number of insulin types and regimens. See also the separate Diabetes with Hypertension article.History of heart failure/chronic kidney disease - SGLT-2 inhibitor or, if not suitable, GLP-1 mimetic.(NB: in the UK, commencement of any SGLT-2 inhibitors is contra-indicated in patients with e GFR below 60.Consider relaxing the target Hb A1c level on a case-by-case basis, with particular consideration for people who are older or frail, for adults with type 2 diabetes: If adults with type 2 diabetes achieve an Hb A1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it.Be aware that there are other possible reasons for a low Hb A1c level - for example, deteriorating renal function or sudden weight loss.Treatment with combinations of medicines including SGLT2 inhibitors may be appropriate for some people with type 2 diabetes.When starting insulin therapy in adults with type 2 diabetes, use a structured programme employing active insulin dose titration that encompasses: When starting insulin therapy in adults with type 2 diabetes, continue to offer metformin for people without contra-indications or intolerance.