The final consideration of type 2 diabetes management is the primary prevention of cardiovascular complications. Details of blood pressure monitoring can be found in the NICE guideline on type 2 diabetes, and users are also signposted to NICE guideline Cardiovascular disease: risk assessment and reduction, including lipid modification (CG181). 

The NICE guideline on type 2 diabetes details complications of the condition, such as: 

• Gastroparesis
• Neuropathy 
• Diabetic foot problems 
• Kidney disease 
• Erectile dysfunction
• Retinopathy. 

The guideline contains either management recommendations or signposts to other relevant guidelines.

Summary

Type 2 diabetes is a progressive, long-term condition that can be slowed by effective glycaemic control. This control is affected by diet and lifestyle modification in the early stages, oral blood glucose lowering medicines alone or in combination and, ultimately, parenteral medicines such as GLP-1 mimetics and insulin. 

In order to slow the progression of micro and macrovascular complications, it is essential to monitor therapy for effectiveness and escalate treatment promptly if targets are not reached. 

Metformin continues to be the best option for initial management in most patients and insulin is likely to be the ultimate destination. This should not be seen as treatment failure, but an inevitable part of the disease progression. 

There are a number of options to be considered at the first and second intensification steps, which are clearly laid out in the algorithm within the NICE guideline. However, the patient's perspective is essential in prioritising the factors that affect medicine choice.