Type 2 diabetes in adults: management

The committee agreed that, when changes to treatment are being considered, it is important to review existing treatment options first. Stopping medications that have not worked, for example, in controlling blood glucose, and optimising current treatments may remove the need to prescribe additional medicines. In particular, there might be factors, such as problems with adherence or adverse effects, that might make existing treatments less effective or ineffective. Addressing these might mean that adding a new medicine is unnecessary.

In the committee's experience, some people have their medications stopped after they reach their glycaemic targets. This can lead to their HbA1c levels and weight rising again. Often, it would be better for the person to keep taking medications that have helped them reach their individualised glycaemic targets, to prevent future problems. There was no evidence on which groups would most benefit from this, so the decision would need to be based on clinical judgement and the preferences of the person with type 2 diabetes.

SGLT-2 inhibitors are a good treatment option for most people and provide cardiovascular and renal protection that cannot be measured by tests. Therefore, the committee agreed that these should be continued even if they do not help the person reach their individualised glycaemic targets.

However, the committee acknowledged that the decision is more complicated for GLP-1 receptor agonists and tirzepatide. For people with atherosclerotic cardiovascular disease or early onset type 2 diabetes, GLP-1 receptor agonists and SGLT-2 inhibitors are being used to prevent cardiovascular events. For these groups, continuing GLP-1 receptor agonists can provide benefits even if they do not help the person reach their glycaemic targets. For people who do not have atherosclerotic cardiovascular disease or early onset type 2 diabetes, GLP-1 receptor agonists and tirzepatide are being used to reach individualised glycaemic targets, so they should be treated like any other medication and stopped if they are not effective for this purpose.

The list of factors to think about as part of optimisation is not exhaustive but includes those that the committee thought were particularly important. The committee agreed that it is important to revisit advice about diet and healthy living. This is because part of this discussion is to ensure the person is supported with both non-pharmacological and pharmacological interventions to improve their current health and prognosis.

The committee agreed that there are cases where treatment with certain medicines highlights diagnostic uncertainty (for example: absence of response to treatments other than insulin, sudden unexpected weight loss). Therefore, the committee highlighted guidance regarding type 1 diabetes and revisiting other diagnoses.

The committee agreed that, when changes to treatment are being considered, it is important to review existing treatment options first. Stopping medications that have not worked, for example, in controlling blood glucose, and optimising current treatments may remove the need to prescribe additional medicines. In particular, there might be factors, such as problems with adherence or adverse effects, that might make existing treatments less effective or ineffective. Addressing these might mean that adding a new medicine is unnecessary.

In the committee's experience, some people have their medications stopped after they reach their glycaemic targets. This can lead to their HbA1c levels and weight rising again. Often, it would be better for the person to keep taking medications that have helped them reach their individualised glycaemic targets, to prevent future problems. There was no evidence on which groups would most benefit from this, so the decision would need to be based on clinical judgement and the preferences of the person with type 2 diabetes.

SGLT-2 inhibitors are a good treatment option for most people and provide cardiovascular and renal protection that cannot be measured by tests. Therefore, the committee agreed that these should be continued even if they do not help the person reach their individualised glycaemic targets.

However, the committee acknowledged that the decision is more complicated for GLP-1 receptor agonists and tirzepatide. For people with atherosclerotic cardiovascular disease or early onset type 2 diabetes, GLP-1 receptor agonists and SGLT-2 inhibitors are being used to prevent cardiovascular events. For these groups, continuing GLP-1 receptor agonists can provide benefits even if they do not help the person reach their glycaemic targets. For people who do not have atherosclerotic cardiovascular disease or early onset type 2 diabetes, GLP-1 receptor agonists and tirzepatide are being used to reach individualised glycaemic targets, so they should be treated like any other medication and stopped if they are not effective for this purpose.

The list of factors to think about as part of optimisation is not exhaustive but includes those that the committee thought were particularly important. The committee agreed that it is important to revisit advice about diet and healthy living. This is because part of this discussion is to ensure the person is supported with both non-pharmacological and pharmacological interventions to improve their current health and prognosis.

The committee agreed that there are cases where treatment with certain medicines highlights diagnostic uncertainty (for example: absence of response to treatments other than insulin, sudden unexpected weight loss). Therefore, the committee highlighted guidance regarding type 1 diabetes and revisiting other diagnoses.