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1. Prevention of Type 2 Diabetes

1.1. Identification and assessment of risk factors for type 2 diabetes 1.2. Management of prediabetes 1.3. Lifestyle interventions for prevention 1.4. Pharmacological interventions for prevention 1.5. Prevention in high-risk populations 1.6. Population-level prevention strategies

2. Screening, Diagnosis and Assessment of Type 2 Diabetes

2.1. Screening for type 2 diabetes 2.2. Diagnostic criteria and methods 2.3. Risk prediction tools for type 2 diabetes 2.4. Screening and diagnosis in special circumstances

3. Glycaemic Monitoring and Targets for Type 2 Diabetes

3.1. Glycaemic targets 3.2. HbA1c monitoring 3.3. Self-monitoring of blood glucose 3.4. Continuous glucose monitoring 3.5. Ketone testing 3.6. Flash glucose monitoring 3.7. Interpretation of glucose monitoring results

4. Lifestyle Management

4.1. Comprehensive lifestyle interventions 4.2. Medical nutrition therapy 4.3. Physical activity interventions 4.4. Health behaviour interventions

5. Self-Management Education and Support

5.1. Diabetes self-management education (DSME) 5.2. Diabetes self-management support (DSMS) 5.3. Diabetes distress and psychological support 5.4. Family, caregiver, and social support

Formal Recommendations Good Practice Statements Informal Recommendations Research only Recommendations Implementation Considerations, Tools, and Tips Remarks

2026 2025 2024 2023 2022 2021 and earlier

无 (8395)Strong (2133)Weak (1206)良好实践声明 (98)NR (19)

无 (7456)High (1539)Very low (1081)Low (967)Moderate (707)

Recommendations

11869 recommendations foundSort

Recommendation Strength: -Evidence: -Formal Recommendations

Green Prescription (GRx) – The GRx Support Person encourages the patient to become active through: - a monthly telephone call for 3-4 months or; - face-to-face meetings for 3 – 4 months or; - group support in the village setting for 3-6 months.

Recommendation No.: 2-2024-035E-040R Guideline No.: 2-2024-035E

Categories: Lifestyle Management

Recommendation Strength: -Evidence: -Formal Recommendations

Lifestyle modifications should target a 5-10% reduction in total body weight if the patient is >30kg/m2 OR a BMI>25kg/m2, or waist circumference > 88 cm for females or > 102 cm for males.

Recommendation No.: 2-2024-035E-039R Guideline No.: 2-2024-035E

Categories: Lifestyle Management, Weight Management in Diabetes

Recommendation Strength: -Evidence: -Formal Recommendations

Initiate basal insulin with weight-based dosing; introduce prandial insulin if HbA1c is above target despite 0.5 units/kg/day doses.

Recommendation No.: 2-2024-035E-038R Guideline No.: 2-2024-035E

Categories: Glycaemic Monitoring and Targets for Type 2 Diabetes

Recommendation Strength: -Evidence: -Formal Recommendations

nitiate insulin at any time if patients have symptoms of insulin deficiency, e.g. weight loss, polyuria, polydipsia, and consider starting insulin at any time if the HbA1c is > 10%.

Recommendation No.: 2-2024-035E-037R Guideline No.: 2-2024-035E

Categories: Glycaemic Monitoring and Targets for Type 2 Diabetes

Recommendation Strength: -Evidence: -Formal Recommendations

Monitor HbA1c levels every three months and escalate treatment if the target is unmet.

Recommendation No.: 2-2024-035E-036R Guideline No.: 2-2024-035E

Categories: Glycaemic Monitoring and Targets for Type 2 Diabetes

Recommendation Strength: -Evidence: -Formal Recommendations

Consider starting metformin and a second-line medicine at diagnosis if the HbA1c is 8%; SGLT2i (GLP1RA) is the preferred second-line medicine for most patients with T2D.

Recommendation No.: 2-2024-035E-035R Guideline No.: 2-2024-035E

Categories: Pharmacologic Glycemic Management of Type 2 Diabetes

Recommendation Strength: -Evidence: -Formal Recommendations

Start lifestyle management and metformin together at diagnosis, in combination with individualised self-management education and support, the Green and Exercise Prescriptions.

Recommendation No.: 2-2024-035E-034R Guideline No.: 2-2024-035E

Categories: Lifestyle Management

Recommendation Strength: -Evidence: -Formal Recommendations

Target HbA1c for most patients with T2D is < 7%

Recommendation No.: 2-2024-035E-033R Guideline No.: 2-2024-035E

Categories: Glycaemic Monitoring and Targets for Type 2 Diabetes

Recommendation Strength: -Evidence: -Formal Recommendations

Pioglitazone, SU, and insulin are now third- and fourth-line agents due to the associated weight gain, risk of hypoglycaemia, and need for SMBG with insulin and SU.

Recommendation No.: 2-2024-035E-032R Guideline No.: 2-2024-035E

Categories: Pharmacologic Glycemic Management of Type 2 Diabetes

Recommendation Strength: -Evidence: -Formal Recommendations

SGLT2i (or GLP1RA) are still the likely preferred second-line agents when escalation of metformin therapy is required (including those aged 10-17 years)—patients without cardiovascular or renal disease who are overweight or obese

Recommendation No.: 2-2024-035E-031R Guideline No.: 2-2024-035E

Categories: Weight Management in Diabetes, Pharmacologic Glycemic Management of Type 2 Diabetes

Recommendation Strength: -Evidence: -Formal Recommendations

The choice between an SGLT2i or GLP1RA - SGLT2i is typically preferable if renal disease or heart failure predominates (GLP1RA is preferable if CVA predominates). If the HbA1c remains above target in this high-risk group, dual SGLT2i (and GLP1RA therapy is recommended but not funded in NZ).

Recommendation No.: 2-2024-035E-030R Guideline No.: 2-2024-035E

Categories: Cardiovascular Disease and Risk Management

Recommendation Strength: -Evidence: -Formal Recommendations

All patients with T2D with either diabetic renal disease OR heart failure OR CV disease OR five-year CV disease risk > 15% should ideally be on metformin, SGLT2i (and/or GLP1RA) regardless of their glycaemic control or other OHA.

Recommendation No.: 2-2024-035E-029R Guideline No.: 2-2024-035E

Categories: Pharmacologic Glycemic Management of Type 2 Diabetes

Recommendation Strength: -Evidence: -Formal Recommendations

The choice of a second-line agent depends on co-morbidities, primarily CV and renal disease.

Recommendation No.: 2-2024-035E-028R Guideline No.: 2-2024-035E

Categories: Chronic Kidney Disease and Risk Management

Recommendation Strength: -Evidence: -Formal Recommendations

Recommend starting insulin immediately if the HbA1c is > 10% (90mmol/mol) at any time, as these patients typically will not reach their glycaemic targets despite lifestyle management and all other glucose-lowering therapies.

Recommendation No.: 2-2024-035E-027R Guideline No.: 2-2024-035E

Categories: Pharmacologic Glycemic Management of Type 2 Diabetes

Recommendation Strength: -Evidence: -Formal Recommendations

Start weight-based basal insulin (rather than the traditional 6-10 unit starting dose) and add prandial insulin once basal insulin doses reach 0.5 units/kg/day.

Recommendation No.: 2-2024-035E-026R Guideline No.: 2-2024-035E

Categories: Pharmacologic Glycemic Management of Type 2 Diabetes

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