How We Recommend Prescriptions

We have developed a set of recommendations for drug therapies for people with Type 2 Diabetes. These are based on current best evidence, considering EASD, ADA and Local Clinician advice and regulations, and will be monitored and updated as practice changes.

These recommendations cover drugs which have glycaemic, cardiovascular (CVD), blood pressure, lipid and renal benefits and consider underlying medications, intolerances, renal status, HbA1C, age, type of diabetes, hypo risk and renal and CVD status.

The tool extracts most of the data needed from the integrated electronic health but will only fully function fully if you complete the online data form also, and update this when any information changes. We will prompt you to check this at least once a year.

Glycaemic and renal medication recommendations

Recommendation for people with impaired renal function are aligned to this decision tree approach:

Glycaemic recommendations for people with normal renal function are aligned to this flow:

Rules before we can make glycaemic and renal recommendations

Before we can make some recommendations, there are various validation checks that we need to do on the patient’s clinical data to ensure that it’s going to give the most appropriate advice.

These rules are:

• Patient must have a Type 2 diagnosis
• Patient is Under the age of 85
• Patient has a stable renal baseline
• Has an HbA1c from the last 12 months
• Has an eGFR in the last 15 months
• Patient has an HbA1c test at least 3 months after a new ‘glycaemic’ medication is issued.

Stable Renal Baseline

Before we make any glycaemic or renal medications, we need to ensure that the clinical data shows that this persons renal function isn’t changing rapidly, and can be understood.

To do this we ensure that we have two consecutive eGFR readings that were taken at and less than 15 months ago and at particular levels:

Lipid Recommendations

If a patient is not currently on any cholesterol lowering medication or statins and has:

• A QRisk > 10
• History of CVD of CCF
• Has type 2 Diabetes and is over the age of 40

then we recommend that they are prescribed a statin or alternative medication if statins are not tolerated.

If a patient has either:

• LDL >2mmol/l or
• Non-HDL > 2.6

and is on Statins or Lipid lowering medication then we recommend escalating lipid lowering medications.

Blood Pressure Recommendations

We will recommend starting or titrating Blood Pressure medication if someone has two consecutive elevated blood pressure records.

Micro-Albumin Recommendations

In addition, we will recommend the use of an ACE inhibitor or Angiotensin receptor blocker in a person with persistently raised ACR level.

Other Recommendations

We also recommend dose reductions and cessation of drugs where appropriate e.g. if licensing recommendation do not cover the patient’s current renal function. 

Predicted impact on Hba1c

We have built some models that can, depending on the current medical regime of the patient, predict (specifically for that patient, not in general terms), what their likely HbA1c would be if they were prescribed different additional medications.