The need for quality prescribing guidance
Type 2 diabetes mellitus: Quality prescribing strategy - a guide for improvement
The purpose of this guide is to promote high quality prescribing in T2DM focusing on safe, person-centred care with shared decision making throughout the process.
A target HbA1c should be discussed with the person and individualised to them, taking account of lifestyle, frailty, comorbidities and medication side effects. This is especially important as decreasing elevated HbA1c levels reduces the risk of long-term complications.
In addition, this guidance will raise awareness of the non-pharmaceutical management of T2DM, provide information that can be used to monitor and review the multiple agents used to treat T2DM and explore variation across Scotland. The scope includes adult with T2DMs only.
This guidance does not replace current clinical guidance and should be used alongside SIGN 116 and 1541. The expert working group also considered the increasing evidence for newer therapies, sodium-glucose co-transporter-2 inhibitor (SGLT-2i) and glucagon-like peptide 1 receptor agonist (GLP-1RA), since publication of the SIGN guidance and the inclusion of these therapies in other national guidelines (such as NICE2 and ADA3). The expert working group considered the place of these therapies in NHS Scotland, recommending their use (see the section on cardiovascular and renal risk).
This guidance provides additional information, such as prescribing safety and effectiveness indicators and guidance regarding the place of newer therapies in treatment, taking a person-centred approach, through the various stages of the disease process.
The figure below shows the journey through the management of T2DM. Click on the image to view a larger version.
