Type 2 Diabetes Treatment Guideline
V5.1 Last reviewed: Nov 2022 Review date: Nov 2025
Nottinghamshire Health Community Treatment Guideline for the Management of Type 2 Diabetes (T2D) in Adults
These guidelines are intended to support prescribing for T2D in adults. Please refer to the BNF or Summary of Product Characteristics for further
information on contraindications, precautions, adverse effects and interactions for any named medicine. This most recent update takes into account
recommendations from NICE in NG28. Currently the use of SGLT2 inhibitors as first line therapy for people with diabetes and at high risk of CVD, but
without established CVD or Heart Failure is not endorsed locally. Therefore, treatment choices for this group should follow the options given in this
guideline.
Contents Page
Summary of patient centred approach in T2D 2
Pre-diabetes 5
Reviewing medications 6
Choosing medicines for T2D 7
Managing Chronic Kidney Disease in T2D 9
Medication notes- metformin 10
Medication notes- SGLT2 inhibitors 12
Medication notes- gliclazide 14
Medication notes- gliptins 15
Medication notes- pioglitazone 16
Medication notes- GLP-1 agonists 18
Insulin therapy 20
References 22
Appendix 1- Dosing in renal impairment 23
Appendix 2- Dosing in hepatic impairment 24
Appendix 3- Table of commonly used insulins 25
1
, Type 2 Diabetes Treatment Guideline
V5.1 Last reviewed: Nov 2022 Review date: Nov 2025
Summary of patient centred
approach in T2D
Lifestyle improvements, BP control
& cholesterol control are important
for macrovascular and microvascular
protection.
Assess and reinforce at every review
and when considering intensification
of medication.
2
, Type 2 Diabetes Treatment Guideline
V5.1 Last reviewed: Nov 2022 Review date: Nov 2025
Lifestyle
Weight
• For adults with T2D who are overweight, discuss and agree an initial body weight loss target of 5% to 10%. Remember that a small amount of
weight loss may still be beneficial, and a larger amount will have advantageous metabolic impact in the long term (NICE).
• Weight loss can offer greater potential benefits than any medication or combination of medications.
• Support available from Nottinghamshire’s Wellbeing Service
• Low calorie diet service: Clinicians can refer eligible patients to nottslowcaloriediet
Physical Activity
Physical activity benefits both mental and physical health. There are several resources available to promote physical activity. Consider signposting
to the following:
• Nottinghamshire Move More
• We are undefeatable
• Active 10 website and app
• Parkrun
Smoking cessation
• Nottingham City: Stub It!
• Nottinghamshire: Stop Smoking
Patient education
• All adults with type 2 diabetes (and/or their carer) should be offered structured education (DESMOND).
• Explain that this is an integral part of diabetes care.
• If a group setting is unsuitable for an individual, an alternative can be offered. Please refer to DESMOND and state on the referral why they
require an alternative. Following structured education (DESMOND), individuals may be referred to a dietitian if they require additional dietary
support. Please state clearly the reason why further support is needed.
Nottingham City: https://www.nottinghamcitycare.nhs.uk/our-services/desmond-diabetes-education-and-self-management-going-and-newly-
diagnosed
Nottinghamshire: https://www.nottinghamshirehealthcare.nhs.uk/desmond-programme-for-type-2-diabetes 3
V5.1 Last reviewed: Nov 2022 Review date: Nov 2025
Nottinghamshire Health Community Treatment Guideline for the Management of Type 2 Diabetes (T2D) in Adults
These guidelines are intended to support prescribing for T2D in adults. Please refer to the BNF or Summary of Product Characteristics for further
information on contraindications, precautions, adverse effects and interactions for any named medicine. This most recent update takes into account
recommendations from NICE in NG28. Currently the use of SGLT2 inhibitors as first line therapy for people with diabetes and at high risk of CVD, but
without established CVD or Heart Failure is not endorsed locally. Therefore, treatment choices for this group should follow the options given in this
guideline.
Contents Page
Summary of patient centred approach in T2D 2
Pre-diabetes 5
Reviewing medications 6
Choosing medicines for T2D 7
Managing Chronic Kidney Disease in T2D 9
Medication notes- metformin 10
Medication notes- SGLT2 inhibitors 12
Medication notes- gliclazide 14
Medication notes- gliptins 15
Medication notes- pioglitazone 16
Medication notes- GLP-1 agonists 18
Insulin therapy 20
References 22
Appendix 1- Dosing in renal impairment 23
Appendix 2- Dosing in hepatic impairment 24
Appendix 3- Table of commonly used insulins 25
1
, Type 2 Diabetes Treatment Guideline
V5.1 Last reviewed: Nov 2022 Review date: Nov 2025
Summary of patient centred
approach in T2D
Lifestyle improvements, BP control
& cholesterol control are important
for macrovascular and microvascular
protection.
Assess and reinforce at every review
and when considering intensification
of medication.
2
, Type 2 Diabetes Treatment Guideline
V5.1 Last reviewed: Nov 2022 Review date: Nov 2025
Lifestyle
Weight
• For adults with T2D who are overweight, discuss and agree an initial body weight loss target of 5% to 10%. Remember that a small amount of
weight loss may still be beneficial, and a larger amount will have advantageous metabolic impact in the long term (NICE).
• Weight loss can offer greater potential benefits than any medication or combination of medications.
• Support available from Nottinghamshire’s Wellbeing Service
• Low calorie diet service: Clinicians can refer eligible patients to nottslowcaloriediet
Physical Activity
Physical activity benefits both mental and physical health. There are several resources available to promote physical activity. Consider signposting
to the following:
• Nottinghamshire Move More
• We are undefeatable
• Active 10 website and app
• Parkrun
Smoking cessation
• Nottingham City: Stub It!
• Nottinghamshire: Stop Smoking
Patient education
• All adults with type 2 diabetes (and/or their carer) should be offered structured education (DESMOND).
• Explain that this is an integral part of diabetes care.
• If a group setting is unsuitable for an individual, an alternative can be offered. Please refer to DESMOND and state on the referral why they
require an alternative. Following structured education (DESMOND), individuals may be referred to a dietitian if they require additional dietary
support. Please state clearly the reason why further support is needed.
Nottingham City: https://www.nottinghamcitycare.nhs.uk/our-services/desmond-diabetes-education-and-self-management-going-and-newly-
diagnosed
Nottinghamshire: https://www.nottinghamshirehealthcare.nhs.uk/desmond-programme-for-type-2-diabetes 3
