management of type 2 diabetes

Management of type 2 diabetes mellitus involves individualizing treatment based on the person's HbA1c target, age, preferences, comorbidities, contraindications, weight, and risks and benefits of treatment ¹.

First-line treatment is standard-release metformin, unless contraindicated ¹.

If blood glucose control is not achieved, consider adding other medications such as a DPP‑4 inhibitor, pioglitazone, sulfonylurea, or SGLT2 inhibitor, based on individual circumstances and NICE guidelines ³.

In cases of symptomatic hyperglycaemia, immediate insulin therapy or a sulfonylurea should be considered, with treatment reviewed once control is achieved ¹.

For adults with established cardiovascular disease or at high risk, consider adding or replacing with an SGLT2 inhibitor with proven cardiovascular benefit ³.

Regular monitoring of HbA1c every 3-6 months until stable, then every 6 months, is recommended ².

Additional management includes lifestyle advice, addressing comorbidities, and considering other treatments such as insulin when indicated, with structured programmes for insulin initiation and titration ³.