Borders Ref Help Toolkit
For referral guidance for people with diabetes please see Refhelp Diabetes diagnosis | Right Decisions
Diabetes prescribing guidance
Type 2 Diabetes Prescribing Guidance for Primary Care
Key Points:
- Lifestyle is first-line therapy and important throughout care. Consider that diabetes remission is possible for some patients and refer patients to Adult weight management | Right Decisions
- Newly diagnosed (within previous 12 months) patients with Type 2 diabetes should also be referred for structured education Control It via this referral form CONTROL IT REFERRAL.doc
- Below is a link to an algorithm that is intended for individuals with above-target glycaemic control where escalation of therapy is indicated. It is not always necessary to modify therapy in individuals who are on regimens that include agents such as Gliclazide, Gliptins or Pioglitazone if glycaemic control is already at target, with no significant side effects, although clinicians may wish to consider if there are patients who might particularly benefit from the weight loss and cardiorenal risk reduction properties of the newer 2nd and 3rd line agents.
– Link to Glucose Lowering Therapy Guidelines for Type 2 Diabetes (this is supplementary to the East Region Formulary) (To be advised, will be added to Refhelp in near future)
Diabetic Targets: Realistic Medicine, frailty, and personalised targets:
- Although SIGN 2017 sets a target of 53mmol/mol for glycaemic control, targets should be individualised. NICE 2022 also recommends personalised targets and for some patients (where treatment is either lifestyle alone or on a single drug that does not cause hypoglycaemia (insulin and sulphonylureas) then a target of 48mmol may be appropriate.
- Patient preference is important – some may be keen to take additional medication or may be reluctant because of the burden of polypharmacy and risks of intensive control.
- Therapeutic targets should be modified in frail individuals. The table below is a summary of therapeutic targets from a UK expert consensus statement from the Foundation for Diabetes Research in Older People
| Health Status | Target HbA1c | Target BP | Lipid Modification |
| Mmol/mol | |||
|
Healthy Rationale: reasonable life expectancy |
<58 | 140/90 | Statins indicated |
|
Intermediate Health Several co-morbidities Limited functional ability Mild to moderate cognitive impairment Rationale: intermediate life expectancy, high treatment burden (polypharmacy), vulnerable to hypoglycaemia and falls. |
<64 | 140/90 | Statins indicated |
|
Poor Health End-stage chronic In long-term care/limited functional ability Moderate to severe cognitive impairment Rationale: limited life expectancy: benefits of treatment uncertain |
<69 | 150/90 | Benefits less certain: greater benefit in secondary prevention |
Patient information leaflets containing:
- Information for People with a new diagnosis of Type 2 Diabetes: Type_2_guide_-_V12_-_Scotland.pdf
- Information on individual medicines for Type 2 Diabetes
- SGLT2 inhibitors Patient information leaflets | Right Decisions
- Oral semaglutide (Rybelsus®) Oral-Semaglutide-Rybelsus-Patient-Information-Leaflet.pdf
- Information for managing diabetes medicines during illness; leaflet in progress
Prescribing Information Formulary | East Region Formulary
See above link to NHS Borders treatment and prescribing guidance for Type 2 diabetes
Patient information leaflets and Prescribing Information - see above