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Be aware that these carry a small risk of euglycaemic diabetic ketoacidosis DPP-4 inhibitors (e.g., sitagliptin, linagliptin), which are generally well tolerated but less effective for weight reduction Metformin , if not already prescribed, remains the first-line oral agent for type 2 diabetes, though it can also cause gastrointestinal upset Insulin therapy , which may be necessary if oral agents and GLP-1 agonists are not tolerated or insufficient, though this carries a risk of hypoglycaemia When discussing alternatives with your GP, consider bringing up: The severity and duration of your symptoms Any dietary or lifestyle modifications you have already tried Your treatment priorities (e.g., cardiovascular protection, convenience) Other medical conditions or medications that may influence treatment choice NICE guidance (NG28) recommends individualised treatment approaches for type 2 diabetes, taking into account patient preferences, comorbidities, and tolerability

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