ACE Clinical Guidances (ACGs)

[also known as Appropriate Care Guides]

ACGs provide concise, evidence-based recommendations to inform specific areas of clinical practice and serve as a common starting point nationally for clinical decision-making. ACGs are underpinned by a wide array of considerations contextualised to Singapore, based on best available evidence at the time of development. Each ACG is developed in collaboration with a multidisciplinary group of local experts representing relevant specialties and practice settings. ACGs are not exhaustive of the subject matter and do not replace clinical judgement.

Published on 20 Nov 2017 | Under Review
Last Updated on 20 Nov 2017
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This Appropriate Care Guide (ACG) continues from the ACG on oral glucose-lowering agents in type 2 diabetes mellitus (T2DM) and highlights the importance of not delaying insulin therapy. It provides clinicians with a practical guide on initiating basal insulin in T2DM and how to prevent and manage hypoglycaemia.

This ACG is currently under review to be updated based on the latest evidence where relevant.

Download the PDF below to access the full ACG.

Key Messages
1. Start insulin therapy if glycaemic goals are not met on oral glucose-lowering agents alone.
2. Initiate with basal insulin, such as intermediate- or long-acting insulin.
3. When initiating insulin, review concomitant oral glucose-lowering agents. Continue metformin +/- SGLT-2 inhibitors where appropriate.
4. Educate patients and their caregivers about taking preventative measures for hypoglycaemia.


Initiating basal insulin in T2DM (Nov 2017)