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Type 2 Diabetes Management Guidelines

SGLT2 inhibitors

  • Special Authority Criteria
  • Patient has type 2 diabetes with an HbA1c > 53 mmol/mol despite at least 3 months of regular use of metformin and/or an alternative glucose lowering therapy, not on a funded GLP1RA (i.e. dulaglutide) AND any of the following:
    • Diabetic renal disease  (urinary albumin:creatinine ratio > 3 mg/mmol and/or eGFR < 60 mL/min) OR
    • Known cardiovascular disease (any ischaemic heart disease, cerebrovascular event, peripheral vascular disease, congestive heart failure or familial hypercholesterolaemia) OR
    • 5 year cardiovascular disease risk > 15% OR
    • A high lifetime cardiovascular risk due to onset of diabetes in childhood or as a young adult OR
    • Māori or Pacific ethnicity

Fournier's gangrene is a type of necrotising fasciitis involving the external genitalia, perineal or perianal areas and may be life threatening. Although the vast majority of genitourinary infections associated with SGLT2 inhibitors are mild, consider acute referral to secondary care if significant pain, fevers and redness out of keeping with mild infection

Risk factors for DKA in type 2 diabetes

  • Previous DKA
  • Insulin deficiency with low carbohydrate diet (e.g < 130 g of carbohydrate per day) and/or significant alcohol use

More reading...

Unapproved medicines and unapproved uses of medicines: keeping prescribers and patients safe


New Zealand Society for the Study of Diabetes. Periprocedural DKA with SGLT2 Inhibitor Use in People with Diabetes - Jan 2022. Available from: https://nzssd.org.nz/assets/table-files/resources-246-resource_file.pdf?title=Periprocedural+DKA+with+SGLT2+Inhibitor+Use+in+People+with+Diabetes+-+Jan+2022