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 03 Jul 2017 | Under Review
Last Updated on 03 Aug 2017
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This Appropriate Care Guide (ACG) highlights the importance of selecting agents based on drug and patient profiles to individualise care; and incorporates latest updates on oral glucose-lowering agents such as SGLT-2 inhibitors and DPP-4 inhibitors, their clinical and cost-effectiveness, safety and appropriate use in patients.

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. Establish patient-centred glycaemic targets.
2. Individualise treatment plans based on drug and patient profiles.
3. Select metformin as the initial glucose-lowering agent as it has long-term efficacy and safety data.
4. Use second generation sulfonylureas when metformin is unsuitable or insufficient in achieving control. Avoid chlorpropamide and glibenclamide as they cause more hypoglycaemia than other sulfonylureas.
5. SGLT-2 inhibitors are appropriate for patients who are at risk of hypoglycaemia, are overweight, or with cardiovascular disease.
6. Reserve DPP-4 inhibitors for patients with renal impairment.


Oral glucose-lowering agents in T2DM (Updated on 3 August 2017)