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Adding a GLP-1 receptor agonist or tirzepatide for adults with type 2 diabetes who are living with obesity, should be considered if: they have been taking initial therapy for at least 3 months and further medicines are needed to reach their individualised glycaemic targets and they are not already taking a GLP-1 receptor agonist or tirzepatide For adults with type 2 diabetes who are living with obesity who need further medicines to reach their individualised glycaemic targets and for whom a GLP-1 receptor agonist or tirzepatide is contraindicated, not tolerated, not appropriate or not effective: offer to add a DPP-4 inhibitor to their current treatment if this is contraindicated, not tolerated or not effective, offer to add: a sulfonylurea or pioglitazone or an insulin-based treatment (see the section on insulin-based treatments) For adults with type 2 diabetes who are living with obesity who need further medicines to reach their individualised glycaemic targets and are already taking a GLP-1 receptor agonist or tirzepatide, offer to add: a sulfonylurea or pioglitazone or an insulin-based treatment (see the section on insulin-based treatments) (6) Adults with chronic kidney disease If type 2 diabetes and an estimated glomerular filtration rate (eGFR) above 30 ml/min/1.73 m2: offer modified-release metformin and an SGLT-2 inhibitor
