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 rang 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.
At all stages review concordance with all measures for glycaemic control.
Dosing schedule weekly titration:
- Gliclazide 80mg bd
- Metform 500mg bd
- Gliclazide 80mg bd
- Metform 850mg bd
- Gliclazide 160mg am, 80mg pm
- Metform 850mg bd
- Gliclazide 160mg am, 160mg pm
- Metform 850mg bd
Metformin intolerance?
- 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 30mg od provided no contraindictions and up titrate gliclazide dose as described.
- If contraindications to Metformin and Pioglitazone, consider Sitagliptin 100mg od but first maximise gliclazide monotherapy.Consider Acarbose or switch to insulin.
On Maximum tolerated metformin/metformin 850mg bd and gliclazide 160mg bd but FPG > 6.0 mmol/L > 2 out of 3 occasions per week?
