Type 2 Diabetes Mellitus - quality prescribing strategy: improvement guide 2024 to 2027

Clinical foreword

Populations are ageing and many people with type 2 diabetes mellitus (T2DM) live with multiple long-term conditions and often prescribed treatments to manage conditions such as cardiovascular or renal disease. It is therefore necessary to ensure the most effective treatment for the individual, alongside a need to consider the place of non-pharmacological approaches to management.

An important principle in improving the care of people with T2DM is to consider their role in shared decision-making and adopting a person-centred approach when considering prescribing choices. It is central to our approach in Scotland that we are providing kind and individualised care to those with T2DM.

We are delighted to present the third edition of the Quality Prescribing Strategy for Type 2 Diabetes Mellitus. Since the publication of the last strategy the prevalence of the condition has increased by 18.8%, from 4.8% of the Scottish population to 5.7%. In addition, there are newer classes of medicines available and increasing evidence for their use. These medicines have benefit for other comorbidities such as atherosclerotic cardiovascular disease, heart failure and chronic kidney disease, all factors that need to be considered in making prescribing choices. This guide is welcomed as an opportunity to further improve the care provided to those with type 2 diabetes. It highlights the importance of addressing health inequalities, lifestyle management and climate and sustainability challenges. The recommendations are aimed at clinicians across the multidisciplinary team, NHS heath boards and GP clusters, and designed to continue the improvement in provision of care.

This third edition has been developed by the collaborative efforts of a multidisciplinary team of clinicians, academics, experts by experience, patient groups and policy makers from across Scotland, from Scottish Government and NHS Scotland, who are already delivering diabetes reviews to improve the outcomes for people with type 2 diabetes. To ensure outcomes from medication are optimised, and prescribing is appropriate and safe, the 7-Steps medication review process provides a clear structure for both the initiation of new and the review of existing treatments, and places an emphasis on ‘what matters to the individual’?

It is recognised that many people in Scotland benefit from pharmaceutical care of diabetes and that polypharmacy is common and a significant challenge. This guide aims to maximise that benefit and ensure safe, appropriate care.

The 7-Steps review process provides a framework for this, considering:

1. Aim: what matters to the person?

2. Need: identify essential medication.

3. Need: any unnecessary medication?

4. Effectiveness: are therapeutic objectives met?

5. Safety: any ADRs/ side effects or a risk of them?

6. Sustainability: cost-effective and environmentally sustainable

7. Person-centred: is the person willing and able to take drug therapy as intended?

We are extremely grateful to all those who contributed to the working group and to the review and development of the guide.

Alpana Mair, Head of Effective Prescribing and Therapeutics

Brian Kennon, National Lead for Diabetes

John Chalmers, Consultant Diabetologist, NHS Fife

Professor Sir Gregor Smith, Chief Medical Officer for Scotland

Alison Strath, Chief Pharmaceutical Officer

Alex McMahon, Chief Nursing Officer

Jason Leitch, National Clinical Director