NHG-Richtlijnen
NHG-Standaard
M01
5.7
In december 2024 is het medicamenteus stappenplan voor patiënten zonder zeer hoog risico geupdatet. Daarnaast zijn er twee wijzigingen toegevoegd voor de zeerhoogrisicopatiënten: Alle patiënten met hartfalen behoren ongeacht de ejectiefractie tot de groep zeerhoogrisicopatiënten en bij zeerhoogrisicopatiënten wordt nu geadviseerd om bij HbA1c ≤ 53 mmol/mol ook een SGLT2-remmer (bij contra-indicatie: GLP1-agonist) te overwegen. Het beleid bij hypoglykemie en hyperglykemie herzien. Er is een paragraaf toegevoegd met een toelichting voor behandeling bij nuchter glucose ≥ 10 mmol/l op moment van diagnose en er is aandacht gekomen voor diabetes mellitus type 2 in remissie. Tenslotte zijn het beleid bij koorts, braken of diarree en de Achtergronden geupdatet.
Onlangs herzien
september 2018
december 2024
T. Endocriene klieren / voeding / metabolisme

Richtlijnen spoed

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Richtlijnen diagnostiek

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Opsporing

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Vaststellen van diabetes mellitus

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Risico-inventarisatie

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Richtlijnen beleid

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Voorlichting en advies

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Niet-medicamenteuze adviezen

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Medicamenteuze behandeling

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Streefwaarden voor bloedglucose en HbA1c

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Praktische uitgangspunten medicamenteuze behandeling

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Behandeling van risicofactoren voor hart- en vaatziekten en chronische nierschade

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Controles

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Driemaandelijkse controle (eventueel door praktijkondersteuner):

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Jaarlijkse controles

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Beleid bij koorts, braken of diarree

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Consultatie en verwijzing

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Belangrijkste wijzigingen

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Kernboodschappen

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Inleiding

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Scope

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Afstemming

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Richtlijnen spoed

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Hypoglykemie

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Patiënt buiten bewustzijn
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Patiënt bij bewustzijn
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Zeer ernstige hyperglykemie

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Achtergronden

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Epidemiologie

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Etiologie en pathofysiologie

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Complicaties

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Cardiovasculaire aandoeningen

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Chronische nierschade

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Neuropathie

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Diabetische voet

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Retinopathie

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Comorbiditeit

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Richtlijnen diagnostiek

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Opsporing

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Vaststellen van diabetes mellitus

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Risico-inventarisatie

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Cardiovasculair risicoprofiel

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Diabetische nefro- en retinopathie

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Voetonderzoek

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Risico op ulcera

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Richtlijnen beleid

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Voorlichting en advies

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Thuisarts
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Kwaliteit van leven
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Niet-medicamenteuze adviezen

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Stoppen met roken

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Voldoende bewegen

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Gewichtsverlies

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Gezonde voeding

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Medicamenteuze behandeling

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Streefwaarden voor bloedglucose en HbA1c

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Streefwaarden HbA1c
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Redenen om af te wijken van streefwaarden
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Aanvullende toelichting streefwaarden
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Praktische uitgangspunten medicamenteuze behandeling

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Medicamenteus stappenplan voor patiënten zonder zeer hoog risico op hart- en vaatziekten

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Algemeen
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Stap 1 Metformine
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Stap 2 Gliclazide toevoegen, eventueel een GLP1-agonist of SGLT2-remmer toevoegen
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Stap 3 Gliclazide, DDP4-remmer, SGLT2-remmer, GLP1-agonist of (middel)langwerkende insuline toevoegen
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Stap 4 Toevoeging ander middel uit stap 3 of intensivering insulinetherapie
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Medicamenteus stappenplan voor patiënten met een zeer hoog risico op hart- en vaatziekten

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Overzetten naar stappenplan voor zeerhoogrisicopatiënten
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Stap 1 SGLT2-remmer
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Stap 2 Metformine toevoegen
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Stap 3 GLP1-agonist toevoegen
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Stap 4 Toevoegen ander middel
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Aandachtspunten bij bloedglucoseverlagende middelen

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Metformine
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SU-derivaten (gliclazide)
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GLP1-agonisten
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SGLT2-remmers
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DPP4-remmers
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(Middel)langwerkende insuline
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Intensiveren insulinebehandeling (facultatief)
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Overige bloedglucoseverlagende middelen
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Dosering van (voorbeelden van) bloedglucoseverlagende middelen
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Behandeling bij nuchter glucose ≥ 10 mmol/L op moment van diagnose

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Bloedglucoseverlagende therapie (exclusief insuline)
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Controles (exclusief insulinetherapie)
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Insulinetherapie
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Diabetes mellitus type 2 en ramadan

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Behandeling van risicofactoren voor hart- en vaatziekten en chronische nierschade

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Bloeddrukverlaging
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Lipidenverlaging
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Chronische nierschade
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Voetproblemen

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Behandeling voetulcus
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Overige behandelingen

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Bariatrische chirurgie

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Controles

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Driemaandelijkse controles

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Jaarlijkse controles

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Lichamelijk onderzoek
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Laboratoriumonderzoek
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Screening op diabetische retinopathie
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Beleid bij koorts, braken of diarree

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Aandachtspunten bij koorts, braken of diarree
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Beleid bij hyperglykemie

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De 2-4-6-regel
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Diabetes mellitus type 2 in remissie

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Vaststellen van diabetes type 2 in remissie
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Controles
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Consultatie en verwijzing

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Voedingsadvies

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Zelfcontroles

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Behandeling met insuline

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Zwangerschapswens

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Vermoeden van MODY of LADA

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Diabetische retinopathie

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Mononeuropathie

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Voetproblemen

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Chronische nierschade

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Gebits- of mondklachten

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Praktijkvoeringsaspecten

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Voorwaarden voor diabeteszorg

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Keuzekaart - Diabetes mellitus type 2
NHG-werkgroep:
Bilo HJG, Dankers M, De Rooij A, Hart HE, Houweling ST, IJzerman RG, Janssen PGH, Kerssen A, Oud M, Palmen J, Stam H, Wiersma Tj.
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