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Appropriate Care Guide

Oral glucose-lowering agents in type 2 diabetes mellitus — an update Published on 3 July 2017 [under review]

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.

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Related Links

Technology Guidance - Drug   Gliclazide for the treatment of type 2 diabetes mellitus

Technology Guidance - Drug   Sodium-glucose co-transporter 2 (SGLT2) inhibitors for type 2 diabetes mellitus

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