DM - Management

Dietary advice

encourage high fibre, low glycaemic index sources of carbohydrates
include low-fat dairy products and oily fish
control the intake of foods containing saturated fats and trans fatty acids
limited substitution of sucrose-containing foods for other carbohydrates is allowable, but care should be taken to avoid excess energy intake
discourage the use of foods marketed specifically at people with diabetes
initial target weight loss in an overweight person is 5-10%

This is an area which has changed in 2015

individual targets should be agreed with patients to encourage motivation
HbA1c should be checked every 3-6 months until stable, then 6 monthly
NICE encourage us to consider relaxing targets on 'a case-by-case basis, with particular consideration for people who are older or frail, for adults with type 2 diabetes'
in 2015 the guidelines changed so HbA1c targets are now dependent on treatment:

Management of T2DM	HbA1c target
Lifestyle	48 mmol/mol (6.5%)
Lifestyle + metformin	48 mmol/mol (6.5%)
Includes any drug which may cause hypoglycaemia (e.g. lifestyle + sulfonylurea)	53 mmol/mol (7.0%)

Practical examples

a patient is newly diagnosed with HbA1c and wants to try lifestyle treatment first. You agree on a target of 48 mmol/mol (6.5%)