Management of Newly diagnosed Type 2 Diabetes Mellitus

• Education (see checklist)
• Dietary and exercise advice
• To see dietician within 4 weeks of diagnosis
• Aim: HbA1c <7.4%

• Patients with severe symptoms (polyuria, polydypsia, weight loss) or significant hyperglycaemia (blood sugars consistently >15mmol/l) may need to be seen sooner and started on treatment earlier

Evaluate at 3 months

If diet and exercise alone fail to achieve target HbA1C initiate monotherapy

Metformin is the usual drug of choice (see Metformin box)

• Consider a sulphonylurea if:
• Slim
• Metformin not tolerated
• Metformin contraindicated

Consider a glitazone if obese and Metformin not tolerated or contraindicated

• Reinforce education and lifestyle advice
• Reassess at 3-6 months

If HbA1c remains high

• Add Sulphonylurea or a Glitazone to Metformin and gradually increase the dose of both appropriately
• If Metformin not tolerated/contraindicated add a Glitazone to a Sulphonylurea
• Reinforce education, diet and lifestyle advice
• Reassess at 3-6 months

If HbA1c remains high

• In obese patients control may be achieved by a comination of Metformin, sulphonylurea and a glitazone.
• There may be a need to start insulin (can discuss with diabetes nurse educators or diabetes centre)
• Stop glitazones in patients starting insulin therapy.
• The use of Metformin with insulin in overweight patients with Type 2 DM reduces insulin dose requirements, reduces weight gain which often follows the intitiation of insulin therapy and may be cardioprotective .

HbA1c (%)	<7	7-8	8-9	>9
Fasting glucose (mmol/l)	<7	7-8	8-9	>9
Control	Ideal	Fair	Poor	Very poor