Diabetes type 2

Diagnosis of Type 2 Diabetes Mellitus

• Type 2 diabetes is diagnosed in adults who are not pregnant by an HbA1c level of 48 mmol/mol (6.5%) or above.
• Alternatively, diagnosis can be made by a random venous plasma glucose concentration ≥11.1 mmol/l, fasting venous plasma glucose concentration ≥7.0 mmol/l, or 2-hour venous plasma glucose concentration ≥11.1 mmol/l after a 75 g oral glucose tolerance test (OGTT).
• In patients without symptoms, the test must be repeated to confirm diagnosis using WHO criteria.

Management of Type 2 Diabetes Mellitus

• Management should be individualized, tailored to the person's preferences, age, comorbidities, contraindications, weight, risks, and benefits of treatment, and polypharmacy.
• Patient education and self-management support are essential, with referral to structured education programmes such as DESMOND recommended to improve outcomes.
• Lifestyle interventions including diet, physical activity, and weight management are foundational.
• Standard-release metformin is the first-line pharmacological treatment unless contraindicated.
• If HbA1c targets are not met (generally aiming for 48 mmol/mol [6.5%] if managed by lifestyle or non-hypoglycaemia drugs, or 53 mmol/mol [7.0%] if on drugs associated with hypoglycaemia), intensify treatment with additional glucose-lowering agents considering cardiovascular and renal protection, safety, tolerability, and cost.
• Self-monitoring of blood glucose is not routinely recommended except for people on insulin, those with hypoglycaemia risk, or specific clinical scenarios such as starting corticosteroids.
• HbA1c should be measured every 3 to 6 months until stable, then every 6 months thereafter.
• Antiplatelet therapy is not recommended for primary prevention in people without cardiovascular disease.
• Blood pressure and cardiovascular risk factors should be managed according to relevant NICE guidelines.