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 NICE CKS.
First-line treatment is standard-release metformin, unless contraindicated NICE CKS.
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 NICE NG28.
In cases of symptomatic hyperglycaemia, immediate insulin therapy or a sulfonylurea should be considered, with treatment reviewed once control is achieved NICE CKS.
For adults with established cardiovascular disease or at high risk, consider adding or replacing with an SGLT2 inhibitor with proven cardiovascular benefit NICE NG28.
Regular monitoring of HbA1c every 3-6 months until stable, then every 6 months, is recommended NICE CKS.
Additional management includes lifestyle advice, addressing comorbidities, and considering other treatments such as insulin when indicated, with structured programmes for insulin initiation and titration NICE NG28.