General Advice
- Refer to NICE NG28 Type 2 diabetes in adults: management. A NICE visual summary and patient decision aid to discuss options with the patient can be found here.
- Integrate dietary advice with a personalised diabetes management plan, including other aspects of lifestyle modification such as increasing physical activity and losing weight.
- Standard-release metformin is the first-line drug treatment for adults with type 2 diabetes. Additional first line treatments e.g. SGLT-2 inhibitors and add on therapies are dependent on cardiovascular status and as such an assessment should be completed to guide treatment. See NG28 on type 2 diabetes for full advice.
- Patients commencing blood glucose lowering agents may need to inform the DVLA and their vehicle insurance company. Advise patients to check with their insurer and the GOV.UK website.
- Patients with type 2 diabetes who become pregnant whilst taking antidiabetic medication should be referred urgently for specialist advice. It is safe to use metformin and insulin but all other blood glucose-lowering agents should be stopped before pregnancy. See NICE NG3 on diabetes in pregnancy.
- Refer patients to the Diabetes UK website for information and support about kidney disease (diabetic nephropathy).
Cautions
Oral hypoglycaemics in elderly patients
- Certain aspects of type 2 diabetes in elderly patients require special consideration. Drug-induced hypoglycaemia is one of the most serious potential complications.
- Risk of hypoglycaemia is increased when combination therapy is used.
- Risk of hypoglycaemia is increased with renal impairment. Decreased renal function in elderly subjects is frequent and asymptomatic. Special caution should be exercised in situations where renal function may become impaired, for example when initiating antihypertensive therapy or diuretic therapy and when starting therapy with a non-steroidal anti-inflammatory drug (NSAID).