Essay Diabetes Type 2

However, they now stratify recommended first-line options for second-line intensification of treatment according to comorbidities: Compelling need to avoid hypoglycaemia - DPP-4 inhibitor, SGLT-2 inhibitor, pioglitazone or GLP-1 mimetic.

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See also the separate Antihyperglycaemic Agents used for Type 2 Diabetes and Insulin Regimens articles.

Offer standard-release metformin as the initial drug treatment for adults with type 2 diabetes.

Add medications if lifestyle advice does not reduce blood pressure to below 140/80 mm Hg (below 130/80 mm Hg if there is kidney, eye or cerebrovascular damage).

Monitor blood pressure every 1-2 months and intensify therapy if the person is already on antihypertensive drug treatment, until the blood pressure is consistently below 140/80 mm Hg (below 130/80 mm Hg if there is kidney, eye or cerebrovascular damage).

If metformin is contra-indicated or not tolerated, consider initial drug treatment with a dipeptidyl peptidase-4 (DPP-4) inhibitor or pioglitazone or a sulfonylurea.

If initial drug treatment with metformin has not continued to control Hb A1c to below the person's individually agreed threshold for intensification, consider dual therapy with metformin combined with one of a DPP-4 inhibitor, pioglitazone or a sulfonylurea.

Measure blood pressure at least annually in an adult with type 2 diabetes without previously diagnosed hypertension or renal disease. Repeat blood pressure measurements within: Provide lifestyle advice (diet and exercise) if blood pressure is confirmed as being consistently above 140/80 mm Hg (or above 130/80 mm Hg if there is kidney, eye or cerebrovascular damage).

See the separate Diabetes Diet and Exercise article.

Dapagliflozin should be stopped if e GFR drops below 60, while empagliflozin or canagliflozin should be stopped if e GFR drops below 45.)Compelling need to lose weight or avoid weight gain - SGLT-2 inhibitor or GLP-1 mimetic (or DPP-4 inhibitor if neither of these is suitable).

The National Institute for Health and Care Excellence (NICE) recommends that with some exceptions, GLP-1 mimetics should only be prescribed for people with a body mass index (BMI) over 35.


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