HbA1c above target despite lifestyle measures.
Regimens
First line
Metformin 500 mg OD with food, up-titrate to 1 g BD
Add-on (CV / renal)
SGLT2 inhibitor (empagliflozin 10 mg OD) if CVD, HF or albuminuria
Add-on (weight)
GLP-1 RA (semaglutide / liraglutide) if BMI ≥35
Insulin
Basal: glargine 10 U or 0.2 U/kg SC nocte; titrate by 2 U every 3 d to fasting 4–7 mmol/L
Monitoring
- • HbA1c every 3–6 months
- • U&E (metformin), foot/eye annually
- • Capillary BG, hypos
Common prescribing errors
- ⚠ Metformin if eGFR <30
- ⚠ Sulphonylurea in elderly + frail (hypo risk)
- ⚠ Not stopping SGLT2i during acute illness (DKA risk)
