Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Recommended management approach for diabetes in adult patients:
Management of diabetes in adults involves individualized care plans considering the type of diabetes, age, preferences, comorbidities, and risks.
- Type 1 diabetes: From age 18 onwards, management focuses on insulin therapy, education, monitoring, and complication prevention NICE CKS.
- Type 2 diabetes: The cornerstone is lifestyle modification including diet, exercise, weight loss, smoking cessation, and alcohol moderation NICE CKS.
- Offer standard-release metformin as first-line pharmacological treatment for type 2 diabetes unless contraindicated NICE CKS,NICE NG28.
- Regular HbA1c monitoring every 3 to 6 months until stable, then every 6 months, with individualized HbA1c targets based on hypoglycaemia risk, age, comorbidities, and preferences NICE NG28.
- If HbA1c targets are not met, intensify treatment stepwise by adding drugs such as DPP-4 inhibitors, pioglitazone, sulfonylureas, SGLT2 inhibitors (especially if cardiovascular or renal disease present), or insulin as needed, considering effectiveness, safety, and patient preference NICE NG28.
- Self-monitoring of blood glucose is not routinely recommended in type 2 diabetes except in specific situations such as insulin therapy, risk of hypoglycaemia, pregnancy, or corticosteroid initiation NICE CKS,NICE NG28.
- Regular screening and management of complications (microvascular and macrovascular) and psychosocial support are integral to care NICE CKS.
- Referral to structured education programmes and multidisciplinary teams as appropriate, advising on diabetes identification and immunizations are also recommended NICE CKS.