DOI: https://doi.org/10.36347/sasjm.2026.v12i06.013

Pages: 645-648

Type 2 diabetes mellitus (T2DM) is a common chronic disease managed predominantly in primary care and is associated with significant cardiovascular, renal, and metabolic complications. The expanding range of antihyperglycaemic therapies has transformed diabetes management, enabling more individualized treatment approaches while increasing the complexity of prescribing decisions. This article provides a practical overview of prescribing in T2DM within primary care, focusing on evidence-based treatment selection, medication initiation and intensification, monitoring requirements, adverse effects, and patient-centred care. Contemporary management extends beyond glycaemic control alone and increasingly emphasizes cardiovascular and renal risk reduction, weight management, avoidance of hypoglycaemia, and improvement of quality of life. Metformin remains the preferred first-line pharmacological therapy for most patients, while sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists play an increasingly important role due to their demonstrated cardiovascular, renal, and metabolic benefits. Other therapeutic options, including dipeptidyl peptidase-4 inhibitors, sulfonylureas, thiazolidinediones, and insulin therapy, continue to have a role in selected patient groups. The article also discusses prescribing considerations in special populations, including older adults, individuals with chronic kidney disease, and patients with established cardiovascular disease. Practical aspects of medication review, monitoring, patient education, sick-day guidance, and shared decision-making are highlighted. Through a clinical case scenario, the article illustrates the importance of tailoring treatment to individual patient characteristics, comorbidities, and preferences. Effective prescribing in T2DM requires a holistic, patient-centred approach that integrates current evidence with long-term cardiovascular, renal, and metabolic risk reductio