L33 Therapeutics of T2DM

- Pre-diabetes: HbA1c [blank_start]41-49[blank_end] mmol/mol Patients should be advised on diet and lifestyle modification​. If >[blank_start]35[blank_end] do CVR assessment. Measure HbA1c [blank_start]yearly[blank_end]. - Diabetes:​ HbA1c ≥ [blank_start]50[blank_end] mmol/mol Full diabetes management​

An HbA1c measurement of > 86 mmol/mol indicates severe diabetes.

Treatment steps: 1. [blank_start]Metformin[blank_end] is first line​ ([blank_start]Acarbose[blank_end]* if patient can’t take metformin or sulphonylureas) 2. Add a [blank_start]sulphonylurea or a DPP-4 inhibitor​[blank_end] 3. [blank_start]Pioglitazone[blank_end] in addition to, or instead of, metformin ± sulphonylurea​ 4. Add [blank_start]insulin[blank_end], usually once or twice daily. and, IF hypertensive (likely); 5. An ACE inhibitor,​ or an [blank_start]angiotensin II receptor blocker[blank_end] (ARB) if not tolerated​ *Low effect, GI tarcet ADRs