The cornerstones of diabetes management are education, dietary advice, alcohol reduction and smoking cessation (where necessary), exercise, weight management and promoting self management of diabetes. Managing type 2 diabetes requires a multi-factorial approach, much like a jigsaw puzzle in which the pieces are education, lifestyle, controlling blood pressure, controlling blood glucose, and the use of medication. Patient-oriented evidence for each of these interventions must be taken into account, and the patient's physical, psychological and social needs, including their own preferences for care, are also important. The targets for each aspect of the condition must be agreed with patients on an individual basis.

Education and lifestyle €“ the first priority must be encouraging people to make lifestyle changes. This includes stopping smoking (the single biggest modifiable risk factor for CVD) and losing weight by modifying their diet and increasing physical activity. Type 2 diabetes is often thought of as being managed by diet, oral treatment and then insulin €“ in that order €“ but, in fact, correct dietary modification underpins treatment at all times, alongside medication. Community pharmacy staff are increasingly being seen as a good source of dietary advice.

Blood pressure €“ controlling blood pressure is important, and diet as well as exercise can help. In people with diabetes, a target BP of 140/80mmHg is often applied. Clinical trials show that adherence to hypotensive medication is important.

Statins €“ treatment of high cholesterol is a priority after lifestyle advice and controlling blood pressure, as it is a risk factor for CVD and macrovascular disease. The effect of treatment should be assessed no longer than three months after starting the statin and then annually thereafter. Statins should not normally be used in women of child-bearing age.

Blood glucose control €“ blood glucose lowering therapies are traditionally used in a stepwise approach based on NICE guidance. An individualised approach is recommended because it requires a careful balance between treating symptoms (such as increased frequency of urination) and preventing complications without causing hypoglycaemia or other unwanted adverse effects. NICE guidance lists the preferred drug treatment for blood glucose control, with metformin first-line, metformin plus sulfonylurea second-line and adding in NPH (intermediate acting) insulin third-line. The patient's glycated haemoglobin (HbA1c) should be measured every two to six months, until it is stable on unchanging therapy, when it can be measured every six months.