Pathways – Dr Duncan Fowler
•Ipswich Hospital Diabetes Centre will
have a more active role in supporting
primary care pathways, through
education, its advice line and email,
outreach and face-to-face contact where
appropriate
•Pathways are usually out of date and
can’t cover all eventualities
•Care should be individualised and the
integrated service will provide ongoing
advice based on up to date data and
medications
• Having said that: pathways still have a
role
Management of Hyperglycemia in Type 2
Diabetes: A Patient-Centered Approach
Position Statement of the American Diabetes Association (ADA) and
the European Association for the Study of Diabetes (EASD)
Diabetes Care 2012;35:1364–1379
Diabetologia 2012;55:1577–1596
Fig. 2. T2DM Antihyperglycemic Therapy: General Recommendations
Fig. 2. T2DM Antihyperglycemic Therapy: General Recommendations
Fig. 2. T2DM Antihyperglycemic Therapy: General Recommendations
Fig. 3. Sequential Insulin Strategies in T2DM
Diabetes Care 2012;35:1364–1379
Diabetologia 2012;55:1577–1596
Indications and therapeutic options for dual therapy in patients with Type 2 diabetes
Commonly occurring situations
Intermittent illnesses:
• Stop metformin
• Rehydrate with non-sugary drinks
Hypercholesterolaemia:
• Atorvastatin – escalate up to 80mg, then refer for consideration of ezetimib
Erectile dysfunction:
• Diabetes is a risk factor for erectile dysfunction but assessment and management of patients is similar
• Medical, psychiatric, surgical, relationship, sexual and drug history
• Clinical examination, including genital examination, blood pressure, heart rate and waist circumference
• Serum lipids, fasting plasma glucose, recent HbA1c, morning testosterone and SHBG
• Consider digital rectal examination and PSA
Combined oral contraceptive:
• Diabetes poses no additional independent risk factor to venous thromboembolism to the established risk
factors
Other Pathways
Renal Impairment
Hypoglycaemia
Anti-platelet therapy – noting that NICE Clinical Guidelines have been superceded by some more recent
evidence
GLP-1 agonists
SGLT2 inhibitors
Foot protection
Autonomic neuropathy, explosive nocturnal diarrhoea and neuropathic pain