Prescribing for people with T2DM
Type 2 diabetes mellitus: Quality prescribing strategy - a guide for improvement
For people with T2DM evidence indicates that as well as addressing glycaemic control, there should be a focus on preventing cardiovascular and renal disease. Therefore, there is an expected increase in use of medicines with cardiovascular and renal benefits, with a reduction in use of drugs without evidence of benefit beyond glycaemic control.
High quality prescribing involves:
- Shared decision making to identify the appropriate therapies for the individual which includes risks and benefits.
- Review of dosage and side effects.
- Consideration of when a treatment is no longer effective and should be stopped.
Clinicians can assess the impact of therapeutic interventions through monitoring glycaemic control or recorded weight, using the SCI-diabetes prescribing timeline tool. A trial of stopping a medicine, with careful monitoring, should be considered when there are doubts regarding the continued benefit to the person. It is also recognised that there will be individuals who require different treatments to those outlined in the guide.
There is a wide variation in glycaemic control in Scotland (information available from SCI DC). While there are times that some individuals will require an individualised target higher than the recommended value e.g. frailty, there may be a large number of people that would benefit from a medication and lifestyle review to optimise outcomes.