Essay Diabetes Type 2

Essay Diabetes Type 2-48
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).

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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If gastroparesis is suspected, consider referral to specialist services if the differential diagnosis is in doubt or if persistent or severe vomiting occurs.

Think about the possibility of contributory sympathetic nervous system damage for adults with type 2 diabetes who lose the warning signs of hypoglycaemia.

If metformin is contra-indicated or not tolerated and initial drug treatment has not continued to control Hb A1c to below the person's individually agreed threshold for intensification, consider dual therapy with: December 2017 - Dr Hayley Willacy draws your attention to the recently published Scottish Intercollegiate Guidelines Network (SIGN) guidelines dealing with the management of glycaemic control in people with type 2 diabetes Update from Dr Sarah Jarvis: In October 2018, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a consensus report on management of hyperglycaemia in type 2 diabetes.

Metformin remains the first-line treatment of choice.

Diabetes is a major risk factor for cardiovascular disease, which is the most common cause of death in people with diabetes.

Optimal control of glucose and other cardiovascular risk factors (eg, smoking, sedentary lifestyle, hypertension, dyslipidaemia and obesity) is essential.Consider relaxing the target Hb A1c level on a case-by-case basis, with particular consideration for people who are older or frail, for adults with type 2 diabetes: If adults with type 2 diabetes achieve an Hb A1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it.Be aware that there are other possible reasons for a low Hb A1c level - for example, deteriorating renal function or sudden weight loss.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.Professional Reference articles are designed for health professionals to use.They are written by UK doctors and based on research evidence, UK and European Guidelines.Review the continued need for other blood glucose-lowering therapies.Start insulin therapy for adults with type 2 diabetes from a choice of a number of insulin types and regimens. See also the separate Diabetes with Hypertension article.If triple therapy with metformin and two other oral drugs is not effective, is not tolerated or is contra-indicated, consider combination therapy with metformin, a sulfonylurea and a GLP-1 mimetic for adults with type 2 diabetes who: In adults with type 2 diabetes, if metformin is contra-indicated or not tolerated, and if dual therapy with two oral drugs has not continued to control Hb A1c to below the person's individually agreed threshold for intensification, consider insulin-based treatment.Only offer a GLP-1 mimetic in combination with insulin with specialist care advice and ongoing support from a consultant-led multidisciplinary team.

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