Type 2 diabetes in adults -management ( NICE 2022 )

Rescue therapy-Consider insulin or a sulfonylurea for symptomatic hyperglycemia and review when blood glucose control has been achieved.

Reinforce diet and advice at each point / opportunity

Choosing treatments -Based on
 individual clinical circumstances ( e.g comorbidities , contraindications , weight , risks from polypharmacy ) individual preferences and needs effectiveness of medication – metabolic response , CV & renal protection safety , tolerability , monitoring licensed indications or combinations , cost

At each point- consider
 stopping medicines that are not tolerated stopping medicines that have had no impact on glycemic control or weight unless there is additional clinical benefits as CV or renal protection with continued treatment how to optimise current treatment regimen before thinking about changing treatments , taking into account factors as
- adverse effects
- compliance
- need to revisit advice about diet & lifestyle
- prescribed doses and formulations whether switching rather than adding drugs could be effective.

An SGLT2 inhibitor. NICE technology appraisal recommends SGLT2 inhibitors recommends that monotherapy with SGLT2s in
 metformin cannot be prescribed diet and exercise alone is not adequate

SGLT2i’s are recommended only if DPP4 inhibitor would otherwise be prescribed and a sulfonylurea or pioglitazone is not appropriate.

REFERENCES

1. Type 2 diabetes in adults- Management NICE Guideline NH28 Overview | Type 2 diabetes in adults: management | Guidance | NICE
2. Moran G M, Bakhai C, Song S H, Agwu J C. Type 2 diabetes: summary of updated NICE guidance BMJ 2022; 377 :o775 doi:10.1136/bmj.o775