Type 2 diabetes

Advice about diet - diet lifestyle adherence to drug treatment

Indivdualised hba1c target- Preferences Co-morbidities Risks from polypharmacy and tight control Ability to achieve longer term risk reduction benefits Measure Hba1c 3-6 monthly as appropriate If Hba1c lower than target and no hypoglycaemia --> encourage to maintain it

Choose drugs based on- Effectiveness Safety Tolerability Individual clinical circumstances Preferences and needs Licensing and cost

Self- monitoring of blood glucose -Do not routinely offer self monitoring unless○ on insulin○ on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery○ pregnant or planning to become pregnant○ evidence of hypoglycaemic episodes

Adults who can take metformin .Hba1c rises to 48 mmol.mol ( 6.5 % ) on lifestyle interventions.Try modified-release metformin if standard metformin not tolerated

Hba1c rises to 58 ( 7.5 % ) →First intensification-Consider dual therapy○ Metformin + DPP4inhibitor○ Metformin + Pioglitazone○ Metformin + Sulphonylurea○ Metformin + SGLT- 2 inhibitor * SGLT-2i * - dapagliflazocin ,canagliflazocin and empagliflazocin are recommended as options in dual Rx with metformin under certain conditions , as options in triple Rx and in combination with insulin. They can also be used as monotherapy in adults who cannot take or tolerate metformin. Warn...