Table 4 Stepwise management of type 2 diabetes

Step 1: Community clinic level

 Prediabetes:

Inform client they may develop diabetes in future

 FBG 5.6–6.9 mmol/l

Advise lifestyle modification

 RBG 7–11 mmol/l

Check blood glucose every 6 months

Step 2: Community clinic level

 Diabetes:

Lifestyle modification if client is committed

 FBG 7–10 mmol/l

If not controlled after 1–3 months go to step 3

 RBG ≥ 11.1–17 mmol/l

If FBG > 10 mmol/l or RBG > 17 go to step 3

For complex clients refer to doctor-led service

Step 3: Initiation at hospital level. Follow up at clinic level when stable

 Failure at step 2 OR

Lifestyle modification

 + 

 FBG > 10 mmol/l

Metformin

 RBG > 17 mmol/l

Step 4: Initiation at hospital level. Follow up at clinic level when stable

 Failure at step 3

Lifestyle modification

 + 

Metformin

 + 

Sulphonylurea

Step 5: Hospital level

 Failure at step 4

Consider insulin

Follow up at hospital