Diabetes mellitus type 2

Clinical criteria:

  • The treatment must be in combination with metformin; unless contraindicated/intolerant,

AND

  • Patient must have cardiovascular disease; OR

  • Patient must be at high risk of a cardiovascular event; OR

  • Patient must identify as Aboriginal or Torres Strait Islander.

Treatment criteria:

  • Patient must not be undergoing concomitant PBS-subsidised treatment for this condition with any of: (i) a GLP-1 receptor agonist, (ii) another SGLT2 inhibitor.

Note

Abbreviations used in the restriction are as follows:

SGLT2 - sodium glucose co-transporter-2 inhibitor (drug names ending in 'flozin')

DPP4 - dipeptidyl peptidase-4 inhibitor (drug names ending in 'gliptin')

GLP-1 - glucagon-like peptide-1 receptor agonist

Note

The Australian Absolute Cardiovascular Disease Risk Calculator is available at www.cvdcheck.org.au.

High cardiovascular risk is defined as an estimated risk of a cardiovascular event of at least 10% over 5 years.

Diabetes mellitus type 2

Clinical criteria:

  • The treatment must be used in combination with at least one of: metformin, a sulfonylurea, insulin,

AND

  • The condition must be inadequately responsive to at least one of: metformin, a sulfonylurea, insulin.

Treatment criteria:

  • Patient must not be undergoing concomitant PBS-subsidised treatment with any of: a GLP-1 receptor agonist, another SGLT2 inhibitor.

Note

Abbreviations used in the restriction are as follows:

SGLT2 - sodium glucose co-transporter-2 inhibitor (drug names ending in 'flozin')

DPP4 - dipeptidyl peptidase-4 inhibitor (drug names ending in 'gliptin')

GLP-1 - glucagon-like peptide-1 receptor agonist

Note

Definition:

A HbA1c measurement greater than 7% despite treatment with the specified prior therapy/therapies indicates inadequate responsiveness. Where HbA1c measurement is clinically inappropriate, blood glucose levels greater than 10 mmol per L in more than 20% of tests over a 2-week period indicates inadequate responsiveness.

Blood glucose monitoring is an alternative to HbA1c measurement where at least one of the following circumstances applies:

(a) A clinical condition with reduced red blood cell survival (inclusive of haemolytic anaemias, haemoglobinopathies),

(b) Red cell transfusion within the previous 3 months.

Document HbA1c measurements (blood glucose measurements where relevant), as well as any intolerances/contraindications in the patient's medical records.