Fast Five Quiz: Type 2 Diabetes Key Aspects

Romesh Khardori, MD, PhD


January 21, 2022

According to guidelines from the National Institute for Health and Care Excellence (NICE), standard-release metformin should be offered as the initial drug treatment for adults with T2D. The dose should be gradually increased over several weeks to minimize the risk for gastrointestinal side effects. The dose of metformin should be reviewed if the eGFR is less than 45 mL/min/1.73 m2. If the eGFR drops below 30 mL/min/1.73 m2 , metformin should be stopped. The guidelines also recommend caution for persons at risk for sudden deterioration in kidney function and those at risk for eGFR falling below 45 mL/min/1.73 m2.

The NICE guidelines also suggest that pioglitazone should not be offered to or continued in adults with T2D if they have any of the following:

In adults with T2D, if initial drug treatment with metformin has not continued to control A1c to below the person's individually agreed threshold for intensification, NICE recommends considering dual therapy with:

  • Metformin and a DPP-4 inhibitor or

  • Metformin and pioglitazone or

  • Metformin and a sulfonylurea

In adults with T2D, if dual therapy with metformin and another oral drug has not continued to control A1c to below the person's individually agreed threshold for further intervention, NICE recommends triple therapy by adding a DPP 4 inhibitor, pioglitazone, or an SGLT2 inhibitor for patients, as appropriate.

Learn more about the treatment of T2D.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.