We have developed a set of recommendations for drug therapies for people with Type 2 Diabetes. These are based on current best evidence, considering EASD, ADA and Local Clinician advice and regulations, and will be monitored and updated as practice changes.
These recommendations cover drugs which have glycaemic, cardiovascular (CVD), blood pressure, lipid and renal benefits and consider underlying medications, intolerances, renal status, HbA1C, age, type of diabetes, hypo risk and renal and CVD status.
Most of the data needed for this tool is supplied form the integrated electronic health record, but will only fully function if you also complete the online data form, remembering to update this when any information changes. We will prompt you to check this at least once a year.
Glycaemic and renal medication recommendations
Recommendations for people with impaired renal function are aligned to this decision tree approach:
Glycaemic recommendations for people with normal renal function are aligned to this flow:
Rules before we can make glycaemic and renal recommendations
Before we can make some recommendations, there are various validation checks that we need to do on the patient’s clinical data to ensure that it’s going to give the most appropriate advice.
These rules are:
- Patient must have a Type 2 diagnosis
- Patient is Under the age of 85
- Patient has a stable renal baseline
- Has an HbA1c from the last 12 months
- Has an eGFR in the last 15 months
- Patient has an HbA1c test at least 3 months after a new ‘glycaemic’ medication is issued.
Stable Renal Baseline
Before we make any glycaemic or renal medications, we need to ensure that the clinical data shows that this persons renal function isn’t changing rapidly, and can be understood.
To do this we ensure that we have two consecutive eGFR readings that were taken at and less than 15 months ago and at particular levels:
| Description | Latest eGFR mL/min/1.73 m2 |
Previous eGFR mL/min/1.73 m2 |
| Mild Renal Impairment | 45-60 | ≥ 30 |
| Moderate Renal Impairment | 30-45 | ≥ 20 |
| Severe Renal Impairment | 20-30 | 20-45 |
| Renal Failure | < 20 | < 45 |
Lipid Recommendations
If a patient is not currently on any cholesterol lowering medication or statins and has:
- A QRISK > 10
- History of CVD of CCF
- Has type 2 Diabetes and is over the age of 40
then we recommend that they are prescribed a statin or alternative medication if statins are not tolerated.
If a patient has either:
- LDL >2mmol/l or
- Non-HDL > 2.6
and is on Statins or Lipid lowering medication then we recommend escalating lipid lowering medications.
Blood Pressure Recommendations
We will recommend starting or titrating Blood Pressure medication if someone has two consecutive elevated blood pressure records.
Micro-Albumin Recommendations
In addition, we will recommend the use of an ACE inhibitor or Angiotensin receptor blocker in a person with persistently raised ACR level.
Other Recommendations
We also recommend dose reductions and cessation of drugs where appropriate e.g. if licensing recommendation do not cover the patient’s current renal function.
Predicted impact on Hba1c
We have built some models that can, depending on the current medical regime of the patient, predict (specifically for that patient, not in general terms), what their likely HbA1c would be if they were prescribed different additional medications.