{"id":8050,"date":"2022-07-15T14:21:48","date_gmt":"2022-07-15T13:21:48","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=8050"},"modified":"2026-04-15T11:32:46","modified_gmt":"2026-04-15T10:32:46","slug":"diabetes-prescribing-guidance","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/diabetes\/diabetes-prescribing-guidance\/","title":{"rendered":"Diabetes-Prescribing Guidance"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Type 2 Diabetes Prescribing Guidance for Primary Care<\/h4>\n\n\n\n<p><strong>Key Points<\/strong><strong>:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Lifestyle&nbsp;is first-line therapy and important&nbsp;<em>throughout care<\/em>. Consider that diabetes remission is possible for some patients and refer patients to&nbsp;<a href=\"\/refhelp\/WeightManagement\/WeightManagement\" target=\"_blank\" rel=\"noreferrer noopener\">Weight Management Service<\/a>.<\/li>\n\n\n\n<li>Newly diagnosed patients with Type 2 diabetes should also be referred for structured education (such as DESMOND) via the weight management service.<\/li>\n\n\n\n<li>The NHS Lothian Diabetes Managed Clinical Network has a&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-health-professionals\/prescribing-information\/\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-health-professionals\/prescribing-information\/\" target=\"_blank\" rel=\"noreferrer noopener\">Prescribing Information<\/a>&nbsp;page and this Ref Help page contains links to guidance on prescribing anti-diabetic medication, anti-hypertensives and statins.<\/li>\n\n\n\n<li>Below is a link to an algorithm that is intended for individuals with above-target glycaemic control where escalation of therapy is indicated.&nbsp;<em>It is not necessary to modify therapy<\/em>&nbsp;in individuals who are on regimens that include agents such as Gliclazide, Gliptins or Pioglitazone&nbsp;<em>if glycaemic control is already at target<\/em>, with no significant side effects.<br><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/New-PC-Guideline-for-Oral-Diabetes-Management-Jan-2026.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Lothian primary care prescribing guidelines for Type 2 diabetes-2026<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/FAQ-for-Tirzepatide-v3.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">FAQ for Tirzepatide (Mounjaro)<\/a><\/li>\n\n\n\n<li>Please be aware of the potential effect of GLP-1 medications on oral progesterone which could affect both contraception and HRT prescribing \u2013 see related guidance in resources and links. Also see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/hrt-and-incretin-based-therapies-glp-1-gip-ras\/\" target=\"_blank\" rel=\"noreferrer noopener\">HRT and incretin-based therapies (GLP-1 &amp; GIP RAs) \u2013 RefHelp<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/services.nhslothian.scot\/diabetesservice\/wp-content\/uploads\/sites\/50\/2026\/03\/Supplementary-Information-for-Lothian-Diabetes-MCN-Type-2-Diabetes-Prescribing-Guidance-for-Primary-Care-updated-Feb-2026.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Supplementary information (FAQs) for the Algorithm<\/strong><\/a><\/li>\n<\/ul>\n\n\n\n<p><strong>Diabetic Targets: Realistic Medicine, frailty, and personalised targets:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Although<strong>&nbsp;SIGN 2017&nbsp;<\/strong>sets a target of 53mmol\/mol for glycaemic control, targets should be individualised.&nbsp;<strong>NICE 2022<\/strong>&nbsp;also recommends personalised targets and for some patients (where treatment is either lifestyle alone or on a single drug that does not cause hypoglycaemia (insulin and sulphonylureas) then a target of 48mmol may be appropriate.<\/li>\n\n\n\n<li>Patient preference is important \u2013 some may be keen to take additional medication or may be reluctant because of the burden of polypharmacy and risks of intensive control.<\/li>\n\n\n\n<li>Therapeutic targets should be modified in frail individuals. The table below is a summary of therapeutic targets from a&nbsp;<a href=\"https:\/\/link.springer.com\/article\/10.1007\/s13300-021-01035-9\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>UK expert consensus statement from the Foundation for Diabetes Research in Older People<\/strong><\/a><strong>:<\/strong><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Health Status <\/strong><\/td><td><strong>Target HbA1c<\/strong><\/td><td><strong>Target BP<\/strong><\/td><td><strong>Lipid modification<\/strong><\/td><\/tr><tr><td>\u200b<\/td><td><strong>mmol\/mol<\/strong><\/td><td>\u200b<\/td><td>\u200b<\/td><\/tr><tr><td><strong>Healthy<\/strong><em> <\/em><br><em>Rationale: reasonable life expectancy<\/em><\/td><td>&lt;58<\/td><td>140\/90<\/td><td>Statins indicated<\/td><\/tr><tr><td><strong>Intermediate Health<\/strong> <br>Several co-morbidities <br>Limited functional ability <br>Mild to moderate cognitive impairment<br><br><em>Rationale: intermediate life expectancy, high treatment burden (polypharmacy), vulnerable to hypoglycemia and falls<\/em><\/td><td>&lt;64<\/td><td>140\/90<\/td><td>Statins indicated<\/td><\/tr><tr><td><strong>Poor health<\/strong> <br>End-stage chronic <br>In long-term care\/ limited functional ability <br>Moderate to severe cognitive impairment<br><br><em>Rationale: limited life expectancy: benefits of treatment uncertain<\/em><\/td><td>&lt;69<\/td><td>150\/90<\/td><td>Benefits less certain: greater benefit in secondary prevention<br><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Patient information leaflets containing:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Information for People with a new diagnosis of Type 2 Diabetes<\/strong><\/li>\n\n\n\n<li><strong>Information on individual medicines for Type 2 Diabetes<\/strong><\/li>\n\n\n\n<li><strong>Information for managing diabetes medicines during illness<\/strong><\/li>\n<\/ul>\n\n\n\n<p><a href=\"https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-patients-and-carers\/patient-information-leaflets\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-patients-and-carers\/patient-information-leaflets\/<\/a><\/p>\n\n\n\n<p>Prescribing Information : <a rel=\"noreferrer noopener\" href=\"https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-health-professionals\/prescribing-information\/\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-health-professionals\/prescribing-information\/\" target=\"_blank\">https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-health-professionals\/prescribing-information\/<\/a><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Patient information leaflets<\/strong>: <a href=\"https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-patients-and-carers\/patient-information-leaflets\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-patients-and-carers\/patient-information-leaflets\/<\/a><\/p>\n\n\n\n<p>Prescribing Information : <a rel=\"noreferrer noopener\" href=\"https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-health-professionals\/prescribing-information\/\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-health-professionals\/prescribing-information\/\" target=\"_blank\">https:\/\/services.nhslothian.scot\/diabetesservice\/information-for-health-professionals\/prescribing-information\/<\/a><\/p>\n\n\n\n<p><strong>FSRH Statement: Glucagon-like peptide-1 (GLP-1) agonists and oral contraception<\/strong> &#8211; <a href=\"https:\/\/www.fsrh.org\/Public\/Public\/Documents\/FSRH-statement-Glucagon-like-peptide-1-agonists-and-oral-contraception-Feb-2025.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.fsrh.org\/Public\/Public\/Documents\/FSRH-statement-Glucagon-like-peptide-1-agonists-and-oral-contraception-Feb-2025.aspx<\/a><\/p>\n\n\n\n<p><strong>Use of incretin-based therapies in women using hormone replacement therapy (HRT) \u2013 Information for GPs &amp; Other health professionals<\/strong> &#8211; <a href=\"https:\/\/thebms.org.uk\/wp-content\/uploads\/2025\/05\/23-BMS-TfC-Use-of-incretin-based-therapies-APRIL2025-E.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/thebms.org.uk\/wp-content\/uploads\/2025\/05\/23-BMS-TfC-Use-of-incretin-based-therapies-APRIL2025-E.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fstaff.nhslothian.scot%2Fdiabetesprofessionaleducation%2Fresources-and-links%2F&amp;data=05%7C02%7Caparna.amanna%40nhs.scot%7Ca7633a2b8c3b4d53595808de9abfcec3%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C639118345768149081%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=T0MOmDea9X9fWCHw5%2B47bFsCiX0yWMnoAadYPHukibM%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">Resources and Links \u2013 Diabetes Professional Education<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Type 2 Diabetes Prescribing Guidance for Primary Care Key Points: Diabetic Targets: Realistic Medicine, frailty, and personalised targets: Health Status Target HbA1c Target BP Lipid modification &#8203; mmol\/mol &#8203; &#8203; Healthy Rationale: reasonable life expectancy &lt;58 140\/90 Statins indicated Intermediate Health Several co-morbidities Limited functional ability Mild to moderate cognitive impairment Rationale: intermediate life expectancy,<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3854,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[702],"class_list":["post-8050","page","type-page","status-publish","hentry","category-diabetes-prescribing-guidance"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/diabetes\/diabetes-prescribing-guidance\/\" rel=\"tag\">Diabetes-Prescribing Guidance<\/a>","rttpg_excerpt":"Type 2 Diabetes Prescribing Guidance for Primary Care Key Points: Diabetic Targets: Realistic Medicine, frailty, and personalised targets: Health Status Target HbA1c Target BP Lipid modification &#8203; mmol\/mol &#8203; &#8203; Healthy Rationale: reasonable life expectancy &lt;58 140\/90 Statins indicated Intermediate Health Several co-morbidities Limited functional ability Mild to moderate cognitive impairment Rationale: intermediate life expectancy,","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/8050","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=8050"}],"version-history":[{"count":25,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/8050\/revisions"}],"predecessor-version":[{"id":27644,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/8050\/revisions\/27644"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3854"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=8050"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=8050"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}