Optimal initial medication

• We suggest the use of metformin as first-line monotherapy in adults with type 2 diabetes.

Optimal Add-On Medication

• We recommend the addition of an SGLT-2 inhibitor to other glucose lowering medication(s) in adults with type 2 diabetes who also have cardiovascular disease, multiple cardiovascular risk factors and/or kidney disease.
• We recommend the addition of a GLP-1 receptor agonist to other glucose lowering medication(s) in adults with type 2 diabetes who have cardiovascular disease, multiple cardiovascular risk factors and/or kidney disease, and are unable to be prescribed an SGLT-2 inhibitor due to either intolerance or contraindication.
• We suggest the addition of a DPP-4 inhibitor to other glucose lowering medication(s) in adults with type 2 diabetes who have cardiovascular disease, multiple cardiovascular risk factors and/or kidney disease, and are unable to be prescribed an SGLT-2 inhibitor or a GLP-1 receptor agonist due to either intolerance or contraindication.
• We suggest the addition of either an SGLT-2 inhibitor, GLP-1 receptor agonist or a DPP-4 inhibitor to metformin in adults with type 2 diabetes who do not have cardiovascular disease, multiple cardiovascular risk factors or kidney disease, and are unable to achieve optimal blood glucose levels.
• We suggest that a sulphonylurea should not be the first choice medication to add to metformin as dual therapy in adults with type 2 diabetes as it may increase the risk of severe hypoglycaemia.
• We suggest that a thiazolidinedione should not be the first choice medication to add to metformin as dual therapy in adults with type 2 diabetes as it may increase the risk of hospitalisation for heart failure.

The guidelines are accessible through MAGICapp here:

https://app.magicapp.org/#/guideline/E5AbPE