Appendix_e_diabetes_treatment_guidelines_septemb_13_portrait_v2

Treatment Options for Patients with Type 2 diabetes - Prescribing Information
PLEASE CHECK FULL SPECIFIC PRODUCT CHARACTERISTICS FOR MORE DETAILED AND CURRENT INFORMATION: http://www.medicines.org.uk/emc/please
Monthly Cost
Contraindications
Cautions and monitoring
requirements
Advantages
Disadvantages
Metformin
Stop if eGFR <30
Use with caution if eGFR <45
Stop in severe acute illness e.g.
sachets when patient has swallowing difficulties. Sulphonylureas
Long acting:
Glibenclamide
Severe renal impairment glibenclamide in the elderly, use a Shorter acting:
Glimepiride
Gliclazide
Tolbutamide
Glipizide
Treatment Options for Patients with Type 2 diabetes - Prescribing Information
PLEASE CHECK FULL SPECIFIC PRODUCT CHARACTERISTICS FOR MORE DETAILED AND CURRENT INFORMATION: http://www.medicines.org.uk/emc/please
Monthly Cost
Contraindications
Cautions and monitoring
requirements
Advantages
Disadvantages
Glitazones
prior initiation in all patients. Do not Cardiac failure or history any other evidence of liver disease. Pioglitazone and should be
continued only if the patient
shows a reduction of at
least 0.5% in HbA1c in 6
months. This should be
explained to the patient at
initiation.

Treatment Options for Patients with Type 2 diabetes - Prescribing Information
PLEASE CHECK FULL SPECIFIC PRODUCT CHARACTERISTICS FOR MORE DETAILED AND CURRENT INFORMATION: http://www.medicines.org.uk/emc/please
Monthly Cost
Contraindications
Cautions and monitoring
requirements
Advantages
Disadvantages
SGLT inhibitors
status (e.g. physical examination, BP measurements,) and electrolytes in blood pressure, which may be more pronounced in patients with very high blood glucose concentrations. Experience in heart failure, NYHA class I-II is limited, and there is no experience in clinical studies with dapagliflozin in NYHA class III-IV. Dapagliflozin has not been studied in combination with glucagon-like peptide 1 (GLP-1) analogues A lower dose of insulin or an insulin secretagogue may be required to reduce the risk of hypoglycaemia when used in combination with dapagliflozin Treatment Options for Patients with Type 2 diabetes - Prescribing Information
PLEASE CHECK FULL SPECIFIC PRODUCT CHARACTERISTICS FOR MORE DETAILED AND CURRENT INFORMATION: http://www.medicines.org.uk/emc/please
Monthly Cost
Contraindications
Cautions and monitoring
requirements
Advantages
Disadvantages
Gliptins
inhibitors)
Sitagliptin:
Pancreatitis – rare, spontaneous
impairment and to 25mg reports of acute pancreatitis, inform Janumet®: only use in
Vildagliptin: Monitor liver function
Vildagliptin:
Sitagliptin:
Vildagliptin:
- do not use in hepatic
Eucreas®: do not use in
patients with CrCl<60
ml/min
Treatment Options for Patients with Type 2 diabetes - Prescribing Information
PLEASE CHECK FULL SPECIFIC PRODUCT CHARACTERISTICS FOR MORE DETAILED AND CURRENT INFORMATION: http://www.medicines.org.uk/emc/please
Monthly Cost
Contraindications
Cautions and monitoring
requirements
Advantages
Disadvantages
Saxagliptin:
Saxagliptin:
Saxagliptin:

- dual therapy –with
metformin or a
sulphonylurea or a
+sulphonylurea ( not
-as combination
Komboglyze®:
- do not use in hepatic

DPP-4 inhibitors should be
Linagliptin▼:
continued only if the patient
shows a reduction of at
Jentadueto®▼:
least 0.5% in HbA1c in 6
months. This should be
explained to the patient at
initiation.
product
Jentadueto®▼
Treatment Options for Patients with Type 2 diabetes - Prescribing Information
PLEASE CHECK FULL SPECIFIC PRODUCT CHARACTERISTICS FOR MORE DETAILED AND CURRENT INFORMATION: http://www.medicines.org.uk/emc/please
Monthly Cost
Contraindications
Cautions and monitoring
requirements
Advantages
Disadvantages
Exenatide(Byetta®)▼ £68.24
In patients taking Byetta®▼and
weekly: Bydureon®▼
disease (exenatide▼).
Liraglutide(1.8mg but
not recommended
with liraglutide in New York Heart
exenatide▼.
Liraglutide: only
-do not use exenatide▼ if Reduction of dose of concomitant Exenatide▼ and
Lixisenatide▼
Bydureon®▼ and
(BMI) ≥ 35 kg/m2 in
Lixisenatide▼ if
liraglutide▼ if <60ml/min. require careful clinical monitoring or Dual Therapy: Continue
therapy if 1% HbA1c reduction
at 6 months. (Please explain to
the patient at initiation.)
Triple Therapy: GLP-1s should
be continued only if there is a
reduction of at least 1.0% in
HbA1c AND a weight loss of at
least 3% of initial body weight,
at 6 months. (Please explain to
the patient at initiation)


Please add in the latest SMBG guidelines in here

Source: http://www.surreyandsussex.nhs.uk/wp-content/uploads/2013/04/Surrey-CCG-DT2Diabetes-Treatments.pdf