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Bij de behandeling van diabetes mellitus type 2 komt bloedglucoseverlagende medicatie in aanmerking, indien geen goede bloedglucoseregulatie wordt bereikt met het aanpassen van de leefstijl. Voor patiënten zonder zeer hoog risico op hart- en vaatziekten is metformine eerste keus bij de medicamenteuze behandeling. Bij onvoldoende resultaat kan een kortwerkend sulfonylureumderivaat (voorkeur gliclazide) worden toegevoegd. De volgende stap conform de NHG-Standaard is (toevoeging van) insulinetherapie, of als alternatief een DPP4-remmer of GLP1-agonist. Bij patiënten met een zeer hoog risico op hart- en vaatziekten, blijkend uit een voorgeschiedenis van hart- of vaatziekte, chronische nierschade en/of systolisch hartfalen, is een SGLT2-remmer eerste keus (alternatief GLP1-agonist). Voeg bij onvoldoende effect eerst metformine toe en vervolgens een GLP1-agonist.
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