Yes
If no contraindictions start dual therapy with gliclazide and metformin:
- Metformin 500mg bd
- Gliclazide 40mg bd
Monitor fasting capillary glucose (FCG) 3X weekly.
Uptitrate weekly if FCG > 10.0 mmol/L > 2 out of 3 occasions.
Uptitrate fortnightly if FCG in range 6.0-9.9 mmol/L > 2 out of 3 occasions.
Stop up titration if target achieved.
At all stages review concordance with all measures for glycaemic control.
Stop up titration if target achieved.
At all stages review concordance with all measures for glycaemic control.
Dosing schedule weekly titration:
- Gliclazide 80mg bd
- Metformin 500mg bd
- Gliclazide 80mg bd
- Metformin 850mg bd
- Gliclazide 160mg am, 80mg pm
- Metformin 850mg bd
- Gliclazide 160mg am, 160mg pm
- Metform 850mg bd
- If there is intolerance to metformin at any dose then go back to the previous dose and titrate up the gliclazide and then retry increased metformin dose in a fortnight.
- If tolerated then proceed with up titration.
- If increased dose not tolerated but tolerated dose > 500mg bd then keep on tolerated dose and maximise gliclazide.
- If completely intolerant to Metformin then initiate treatment with Pioglitazone 15mg od provided no contraindictions (consider fracture risk , do not use > 10% www.shef.ac.uk/FRAX/ to caculate)and up titrate to 45mg every 4 weeks and uptitrate glicazide dose as described.
- If contraindications to Metformin and Pioglitazone then treat with gliclazide monotherapy and consider Acarbose/sitagliptin or switch to insulin.
On Maximum tolerated metformin/metformin 850mg bd and gliclazide 160mg bd but FPG >7.0 mmol/L > 2 out of 3 occasions per week?
