Frame-zoom – Local Clinical Pathways

For further guidance please refer to full North West London Diabetes Guidelines
DiRECT; Lancet 2018; 391: 541–51 https://doi.org/10.1016/S0140-6736(17)33102-1
NWL REWIND Programme (Reducing Weight with Intensive Dietary support) For more details, click here.
When prescribing an SGLT-2i, consider risk of volume depletion, euglycemic DKA in insulin deficient pts and lower limb amputation (class warning, but only observed in Cana and Eurtu). Caution in frail pts & always follow sick day rules. Refer to full North West London Diabetes Guidelines
DECLARE TIMI 58; N Engl J Med 2019; 380:347-357; DOI: https://doi.org/10.1056/NEJMoa1812389
FDA Drug Safety Communication: FDA adds warnings about heart failure risk to labels of type 2 diabetes medicines containing saxagliptin and alogliptin https://bit.ly/2ZZCNni
TZD (Pioglitazone) to be avoided in patients with heart failure. PROactive; Lancet. 2005 Oct 8;366(9493):1279-89 https://doi.org/10.1016/S0140-6736(05)67528-9
REWIND (Dulaglutide CVOT); Lancet 2019; 394: 121–30; DOI: https://doi.org/10.1016/S0140-6736(19)31149-3
Patients with established atherosclerotic cardiovascular disease having had an ischemic event (e.g myocardial infarction or stroke)
Consider initiating Met + SGLT-2i rather than stepwise. This is in line with Position Statement by Primary Care Diabetes Europe; S. Seidu, et al., A disease state approach to the pharmacological management of Type 2 diabetes in primary care: A position statement by Primary Care Diabetes Europe, Prim. Care Diab. (2020), https://doi.org/10.1016/j.pcd.2020.05.004. Alternatively, the European Society of Cardiology (ESC) diabetes guideline states that SGLT-2i could be considered as first line ahead of metformin in patients with eCVD, HF or CKD - European Heart Journal (2019) 00, 169; doi: https://doi.org/10.1093/eurheartj/ehz486
EMPA-REG; N Engl J Med 2015; 373:2117-2128; DOI: https://doi.org/10.1056/NEJMoa1504720
CANVAS; N Engl J Med 2017; 377:644-657; DOI: https://doi.org/10.1056/NEJMoa1611925
PIONEER 6; N Engl J Med 2019; 381:841-851; DOI: https://doi.org/10.1056/NEJMoa1901118
SUSTAIN 6; N Engl J Med. 2016 Nov 10;375(19):1834-1844 DOI: https://doi.org/10.1056/NEJMoa1607141
ABCD SGLT-2i & GLP-1 Position Statement (2021) Basu, et al. BJD. 2021; 21(1): 132-148 https://bit.ly/3zXBWmf
DAPA HF; N Engl J Med; September 19, 2019; DOI: https://doi.org/10.1056/NEJMoa1911303
CREDENCE; N Engl J Med 2019; 380:2295-2306; DOI: https://doi.org/10.1056/NEJMoa1811744
DAPA CKD; N Engl J Med 2020; 383:1436-1446; DOI: https://doi.org/10.1056/NEJMoa2024816
EMPOROR REDUCED; N Engl J Med 2020; 383:1413-1424 DOI: https://doi.org/10.1056/NEJMoa2022190

NWL Diabetes Guidelines