Early and optimal glycaemic control in patients with type 2 diabetes is imperative for reducing microvascular
and potentially macrovascular complications. Glycated haemoglobin remains the key focus of glycaemic
management although targets should be individualised based on age, comorbidities and life expectancy.
Treatment choice should be guided by patient comorbidities, adverse effect profile, acceptability of the
method of administration and cost. Metformin remains first-line treatment unless contraindicated. Insulin may
be considered at any stage, particularly where control is poor. Patients with pre-existing cardiovascular disease
can be safely managed with new agents, including some DPP4-inhibitors, GLP-1 receptor agonists and SGLT-2
inhibitors and some therapies may offer cardiovascular mortality benefit.
Modern Medicine – February 2018