www.diabeticretinopathy.org.uk

Type 2 diabetes: a treatment plan (separate page)

Proceed down until target reached:
address   diet   exercise   losing weight   learn to test glucose

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0-8 weeks, if levels higher than HbA1c 48 mmol/mol / 6.5% at onset of diabetes if well

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add Metformin  
increase to 2.0 - 2.5gm over 3 months (divided doses)

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0-8 weeks, if levels higher than HbA1c 48 mmol/mol / 6.5% .
this is the target for recently diagnosed patients

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if low weight if overweight
  • Sitagliptin & Linaglyptin (Trajenta) do not cause weight gain, but all the other treatments below increase weight
  • Linaglyptin (Trajenta) if renal function reduced
  • If thin, sulphonylurea and titrate to maximum dose depending on response. Eg gliclazide. start 40-80 mg daily. 160 mg as a single dose, with breakfast; higher doses divided; max. 320 mg daily. Weight will increase. Sulphonylurea do cause hypos.
  • Dapagliflozin (Farxiga) if well
  • or add insulin as below

These drugs (and only one of this list would normally be added) will only lower the HbA1c 0.5-1.0%.

Therefore if the HbA1c is >8.5% 69mmol/l, a 7.5% /58mmol/ltarget will not be reached, so insulin may be best. However, a gradual HbA1c drop may be best in retinopathy patients.

Incretins

Reduced renal function

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12 weeks, if levels higher than target (>HbA1c 48 mmol/mol / 6.5% at onset)

Add insulin

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12 weeks, if levels higher than target