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[39] Type 2 Diabetes Special Considerations for People With T2D and Overweight/Obesity Incretin therapies are not currently licensed for use in people with T1D and overweight/obesity [3][5][9][12][14] Deprescribe any DPP4 inhibitor if initiating an incretin therapy Based on the findings of a systematic review and meta-analysis, people without T2D may achieve significantly greater mean weight loss with GLP-1 RAs than people with T2D [40] Risk of hypoglycaemia is low if the incretin therapy is not used alongside insulin or SUs [3][5][9] people with T2D taking insulin or SUs may need to lower the dosage of these medications initially when starting incretin therapies, to reduce the risk of hypoglycaemia [3][5][9][41] SMBG is necessary when adjusting the dose of SU or insulin, and a stepwise approach to insulin reduction is recommended [41] DKA risk the MHRA (2019) [41] warns of reports of DKA when insulin is rapidly reduced or discontinued alongside GLP-1 RAs any dose reduction of insulin should be done in a stepwise manner, with careful SMBG [41] Retinopathybe aware that pre-existing DR may be worsened if HbA 1c is rapidly lowered on initiation or escalation of incretin therapy use all incretin therapies with caution in patients who have DR requiring active ophthalmology follow up, suboptimal glycaemic control (HbA 1c 86 mmol/mol), and are currently being treated with insulin [42][43][44] ensure that all people living with T2D being considered for incretin therapies are up to date with retinal screening
