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Table 2 ADDITION-Leicester algorithm for the management of hyperglycaemia, hypertension and dyslipidaemia.

From: Rationale and design of the ADDITION-Leicester study, a systematic screening programme and Randomised Controlled Trial of multi-factorial cardiovascular risk intervention in people with Type 2 Diabetes Mellitus detected by screening

  Basic Treatment
TARGET
add if above TARGET add if above
TARGET +BMI>19
or creatinine>130
Supplementary treatment
If still above TARGET
Blood
Glucose
HbA1c <6.5%
SMBG Tuition
DESMOND
Dietary Advice
HbA1c >6.5%
SMBG Tuition
DESMOND
Biguanide
HbA1c >6.5%
SMBG Tuition
DESMOND
Insulin
HbA1c >6.5%
Biguanide
Sulphonylureas
Thiazolidinediones
THEN
Stop TZD
Add basal Insulin
(bedtime)
HbA1c >6.5%
and on
Biguanide
Sulphonylureas
Insulin
(basal/bolus)
Intensify & titrate
Insulin
Blood
Pressure
BP
< 130/80 mmHg
No treatment
BP
>130/80 mmHg
ACE
BP >135/80 mmHg
ARB
CCB
Thiazide
BP
>130/80 mmHg
ACE
ARB/CCB
Thiazide
alpha/beta Blocker
Cholesterol <3.5 mmol/L
Diet
> 3.5 mmol/L
TG >6.0 mmol/L
Diet
Statin
Consider
Ezetimibe/Fibrate
   
Aspirin 75 mg to all patients, unless contraindications of gastrointestinal bleeding, ulcers or haemophilia.
If Aspirin contraindicated, consider Clopidogrel.
  1. KEY
  2. ACE: Perindopril 2-4 mg daily or Ramipril 2.5-10 mg daily
  3. SMBG: self-monitored blood glucose
  4. Biguanide: Metformin 1-2 g daily
  5. Sulphonylurea: Gliclazide MR 30-120 mg daily or Glimepiride 1-4 mg daily
  6. Insulin: Basal analogue: Glargine. Short-acting analogue: Novorapid or Premixed: Novomix30 twice daily
  7. Thiazolidinedione: Pioglitazone 30-45 mg daily
  8. ARB: Angiotensin receptor blocker: Losartan 25-50 mg daily
  9. CCB: Calcium Channel Blocker: Amlodipine 5 mg daily
  10. Thiazide: Bendrofluazide 2.5 mg daily
  11. Alpha/beta blocke r: Doxazosin MR 4-8 mg or Bisoprolol 5-10 mg daily
  12. Statin: Simvastatin 20-40 mg or Atorvastatin 20-40 mg daily
  13. Fibrate: Fenofibrate (micro) 267 mg or Bezafibrate MR 400 mg daily