What next after Metformin - New guidelines

Description

Part of the LWN diabetes series gives an overview of the new guidelines for Type 2 diabetes treatment when moving on from Metformin

Delivered in a 40-minute bite-sized webinar by Learn With Nurses Diabetes Specialist Nurse Judy Downey

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What next after Metformin? – New guidelines th 24 February 2023 Judy Downey RGN BSc hons Independent Diabetes Nurse Consultant @Lwnurses #LWN #LearnWithNurses Associate Trainer Education for Health UniversityLecturer New South Bucks Author Practice Nurse Journal Diabetes Society Member Primary Care @DowneyJude2757NG28 Update February 2022 – What has changed? •The need for treatment individualisation has been emphasised and is now supported by a downloadable patient decision aid. •Where possible, SGLT2 inhibitors are now recommended first-line, as dual therapy with metformin, in any individual with atherosclerotic cardiovascular disease, chronic heart failure or high risk of cardiovascular disease. •GLP-1 RAs remain a fourthline option for glycaemic control, which puts the NICE guideline at odds with most other international guidelines.Mr C Father had MI aged 56 Cholesterol/HDL ratio 4.8 Qrisk score of 58% Age (years): 52 BMI (kg/m ): 29 Type 2 diabetes Newly diagnosed diagnosed: HbA 1c 68 mmol/mol (8.4%) Diabetes medication: N/A eGFR (ml/min): 90 Lipids (mmol/L): TC 4.8 HDL 1.0 LDL 3.0 TG 2.2 Blood pressure (mmHg): 158/88 Ethnicity: South Asian Lifestyle: Smokes 10/day; 20 units alcohol/week; eats out regularly Occupation: Accountant Mr C What happens next?Communicating risk to patients Mr C 6 MONTHS LATER Using Updated NICE Guidelines Commence Dapagliflozin soon after Metformin Age (years): 52 BMI (kg/m2): 29 Type 2 diabetes diagnosed: 6 months HbA : 68 62 mmol/mol (7.8%) 1c Diabetes medication: Metformin 1000 mg bd Dapagliflozin 10 mg eGFR (ml/min): 90 Lipids (mmol/L): TC LDL TG 1.8 Atorvastatin 20mg 4.0 HDL 1.2 2.7 OD Blood pressure (mmHg): 129/82 Lisinopril 10mg Ethnicity: South Asian Lifestyle: Smokes 10/day; 20 units alcohol/week; eats out regularly Occupation: Accountant 1 year after diagnosis Mr C Cholesterol/HDL ratio 3.3 Qrisk score of 37.4 Age (years): 53 BMI (kg/m 2): 29 26 Type 2 diabetes 12 months diagnosed: HbA 1c 62 mmol/mol 54 mmol/mol (7.1%) Diabetes medication: Metformin 1000 mg bd; Dapagliflozin 10 mg eGFR (ml/min): 85 Lipids (mmol/L): TC 4.0 HDL 1.2 LDL 2.7 TG 1.8 Blood pressure 125/80 (mmHg): Lifestyle: Smokes 10/day; 20 units alcohol/week; eats out regularly Occupation: Accountant Resources • https://www.nice.org.uk/guidance/ng28 • Management of Type 2 Diabetes 2018. A Consensus Report by ADA and EASD • Phcuk.org – resources – Sugar Infographics • Trend-uk.org – patient information leaflets • Diabetes.org.uk – professionals – Information Prescriptions • Lowcarbprogram.com – 40 day Kickstart Programme • Carbs and Cals World Foods • GP Notebookeducation.com