The most appropriate treatment for type 2 diabetes mellitus begins with lifestyle interventions including dietary advice, increased physical activity, weight loss, smoking cessation, and alcohol moderation, tailored to individual needs and preferences.
If lifestyle changes alone are insufficient to achieve glycaemic control, metformin is the first-line pharmacological treatment recommended for most adults and children over the age of 12 years.
Regular monitoring of HbA1c is essential to assess treatment effectiveness and guide further management, with individualized glycaemic targets agreed upon considering risks such as hypoglycaemia and patient quality of life.
When metformin and lifestyle measures fail to maintain target HbA1c levels, additional blood glucose lowering drugs may be added based on individual factors and risk profiles.
In some cases, particularly with progressive beta-cell failure or severe hyperglycaemia, insulin therapy may be required and should be initiated and managed by healthcare professionals with expertise in diabetes.
Ongoing support includes structured education, screening for complications, psychosocial support, and immunizations as indicated.
Summary of treatment steps:
- Lifestyle modification (diet, exercise, weight loss) NICE CKS,NICE NG28,NICE NG18
- Metformin monotherapy as first-line drug NICE NG28,NICE NG18
- Individualized HbA1c targets and regular monitoring NICE NG28
- Addition of other glucose-lowering agents if needed NICE NG28
- Insulin therapy if oral therapies are insufficient NICE CKS,NICE NG28
- Comprehensive care including education, complication screening and immunizations NICE CKS,NICE NG28,NICE NG18