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C
B
D
The use of omega 3 fatty acids could be considered for diabetic patients with severe
hypertriglyceridemia who do not respond satisfactorily to other means (diet and drugs).
It is not necessary to contraindicate the moderate consumption of alcohol in diabetic patients
with this habit, unless there are other medical criteria which require it. In any case,
it is recommendable to limit the intake of alcohol to a maximum of two-three units per
day in the case of men and one-two units in the case of women.
Fixed menu diets can be used, or portion exchange diets or those based on simplified
guidelines, depending on the patient, the specialist or the health environment.
Exercise
A
In DM 2 patients, the practice of regular and continuous physical exercise is recommended,
of aerobic or anaerobic intensity, or preferably a combination of both. The recommended
frequency is three sessions per week on alternate days, progressive in duration
and intensity and preferably under supervision.
Glycemic control
Glycemic control with oral antidiabetic drugs
HbA 1
c targets
D
In general, orientative targets under 7% for HbA 1
c are recommended. However, the target
should be based on an individual assessment of the diabetes risk complications, comorbidity,
life expectancy and patients’ preferences. A more intensive control is recommended
for patients with microalbuminuria within the context of a multifaceted intervention
to reduce cardiovascular risks. Likewise, less strict targets can be appropriate for patients
with a limited life expectancy, elderly or individuals with comorbidity conditions, with a
previous hypoglycaemia history or patients with long-term diabetes.
Initial treatment with monotherapy
D
D
A
B
If after a three-six months treatment with non-pharmacological measures glycaemic targets
are not achieved, it is recommended to start pharmacological treatment.
Oral glucose lowering drugs should be prescribed within a trial period and its effects
should be monitored according to HbA 1
c levels.
Metformin is the preferred drug for people overweight or suffering from obesity (BMI
≥25,0 kg/m 2 ).
Metformin is also the first line option for people not overweight.
C Metformin is contraindicated for patients with renal failure (serum creatinine over 1,5
mg/dl for men and 1,4 mg/dl for women).
A
Sulfonylureas should be considered as initial treatment when mwtformin is not tolerated
or is contraindicated and it can be used on patients not overweight.
18 CLINICAL PRACTICE GUIDELINES IN THE NHS