How should I adjust the management plan for a patient with type 2 diabetes who presents with hyperglycaemia despite adherence to their current treatme

If a patient with type 2 diabetes presents with hyperglycaemia despite adherence to their current treatment regimen, the management plan should be adjusted as follows:

• Reinforce lifestyle advice and adherence: Reassess and reinforce advice about diet, physical activity, and adherence to medication to ensure optimal self-management.
• Set and support an individualized HbA1c target: Support the patient to aim for an HbA1c target of around 53 mmol/mol (7.0%), tailored to their individual needs and circumstances.
• Intensify pharmacological treatment: If HbA1c remains ≥58 mmol/mol (7.5%) despite current therapy, intensify drug treatment by adding medications with different mechanisms of action, considering patient factors such as comorbidities, risk of hypoglycaemia, weight, and preferences.
• Consider immediate insulin or sulfonylurea if symptomatic: If the patient is hyperglycaemic with symptoms, consider starting insulin or a sulfonylurea promptly, with specialist advice.
• Monitor HbA1c and glucose control regularly: Measure HbA1c every 3 to 6 months until stable, then every 6 months, and review treatment accordingly.
• Evaluate for other causes and complications: Investigate any discrepancies in glucose control, consider comorbidities, and assess for complications that may affect management.

This approach ensures comprehensive reassessment and intensification of therapy to achieve better glycaemic control while considering patient safety and preferences.

References: ¹,²,³