Type 2 Diabetes Clinical Pathway

Authored by Partha Kar, published on 2026-04-18 08:35:41.0

Global HbA1c Conversion ReferenceFor a global audience, targets are often expressed in two different units: Standard Percentage (%) | SI Units (mmol/mol) | Context6.5%    |    48 mmol/mol    |    Early diagnosis / Tight control 7.0%    |    53 mmol/mol    |    Standard Global Target 8.0%     |    64 mmol/mol    |    Frail / Elderly / High hypo risk

  1. DIAGNOSIS & FOUNDATION: Life/Style/Exercise 1st line: Metformin (unless contraindications) Consider SGLT2i earlier
    Action: Immediate Lifestyle Intervention (Diet, Exercise, Weight Loss). First-Line Med: Start Metformin (unless contraindicated). If high-risk (Heart/Kidney disease): Consider adding SGLT2i or GLP-1 RA immediately. ↓ Target not met (3–6 months)
    • DUAL THERAPY
      Action: Continue Metformin + Add 2nd Agent. ↓ Target not met (3–6 months)
      • If Weight is priority: Choose GLP-1 RA or GIP/GLP-1.
        • TRIPLE THERAPY
          Action: Continue current meds + Add 3rd Agent from a different class. Goal: Maximise non-insulin options to reduce hypoglycaemia (low blood sugar) risk. ↓ Target not met
          • INTENSIFICATION
            Action: Start Basal Insulin (or GLP-1 RA if not already used). Titration: Adjust doses weekly based on fasting glucose levels until the HbA1c target is achieved.
      • If Heart/Kidney priority: Choose SGLT2i or GLP-1 RA.
        • TRIPLE THERAPY
          Action: Continue current meds + Add 3rd Agent from a different class. Goal: Maximise non-insulin options to reduce hypoglycaemia (low blood sugar) risk. ↓ Target not met
          • INTENSIFICATION
            Action: Start Basal Insulin (or GLP-1 RA if not already used). Titration: Adjust doses weekly based on fasting glucose levels until the HbA1c target is achieved.
      • If Cost is priority: Choose Sulfonylurea or Pioglitazone.
        • TRIPLE THERAPY
          Action: Continue current meds + Add 3rd Agent from a different class. Goal: Maximise non-insulin options to reduce hypoglycaemia (low blood sugar) risk. ↓ Target not met
          • INTENSIFICATION
            Action: Start Basal Insulin (or GLP-1 RA if not already used). Titration: Adjust doses weekly based on fasting glucose levels until the HbA1c target is achieved.
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