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Primary Care GuidelinesAuthor: Juan Fernando Florido Santana
A podcast intended for healthcare professionals wanting to keep up to date relevant information about clinical practice guidelines Language: en-us Genres: Education, Health & Fitness, Medicine Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Podcast - NICE 2026 Type 2 Diabetes Guideline – Part 5: Insulin Treatment and Complications
Tuesday, 21 April, 2026
The video version of this podcast can be found here: · https://youtu.be/URcxCjFEFRMThis episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I review the NICE guideline on Type 2 diabetes in adults: management, always focusing on what is relevant in Primary Care only.I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido. Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The NICE clinical guideline on Type 2 diabetes in adults: management [NG28] can be found here: · https://www.nice.org.uk/guidance/ng28 TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I’m Fernando, a GP in the UK. Today we are looking at the new updated NICE guideline on type 2 diabetes in adults, always focusing on what is relevant in Primary Care only.The diabetes guideline is a comprehensive document, so I am breaking it down into clear and practical sections.Today, we are focusing on insulin-based treatment and the management of complications.In recent episodes, we covered the earlier sections.Right, let’s jump into it.First, let’s look at insulin-based treatments.When we start insulin in adults with type 2 diabetes, we should provide structured education. This education should cover aspects like injection technique, self-monitoring, dose titration, fitness to drive advice, managing hypoglycaemia, and managing acute changes in glucose.When initiating insulin, we should continue metformin in people already taking it.We should stop any other medicines used solely to manage hyperglycaemia.And we should discuss the risks and benefits of continuing medicines that have other benefits, for example cardiovascular protection or weight management.As initial insulin therapy, we should offer a basal insulin intended for once or twice daily use.If HbA1c is very high, especially 75 mmol per mol or higher, we should consider starting with basal insulin plus a short or rapid acting insulin. This can be given as separate injections, or as a premixed, biphasic insulin preparation.When choosing the insulin preparation, we should take into account whether the person needs help with injections, whether there is concern about nocturnal hypoglycaemia, and whether once daily injections would be preferred.If more than one basal insulin type is equally suitable, we should choose the least expensive option.We should consider premixed preparations that include insulin analogues rather than human insulin if the person wants to inject immediately before meals, if hypoglycaemia is a problem, or if glucose rises significantly after meals.At each review, we should check whether someone on basal insulin also needs bolus insulin before meals, or a move to a premixed biphasic regimen.At each review, if someone is on premixed biphasic insulin and their targets are not met, we should check whether they need to switch to a different premix or move to a basal bolus regimen.Now let’s move to complications.At annual review, we should advise adults with type 2 diabetes that they are at higher risk of periodontitis.We should explain that treating periodontitis can improve blood glucose control and can reduce the risk of hyperglycaemia.We should advise regular oral health reviews, and if periodontitis is diagnosed, we should offer dental appointments at a frequency based on their needs.We should think about gastroparesis in adults with erratic blood glucose control or unexplained bloating or vomiting, while considering alternative diagnoses.If vomiting is caused by gastroparesis, we should explain that there is no strong evidence that antiemetic treatments are effective. Some people may benefit from domperidone, erythromycin, or metoclopramide.We should be clear that domperidone has specific safety risks, particularly cardiac risk and drug interactions, so we need to prescribe cautiously.For treatment, we should consider alternating erythromycin and metoclopramide.We should only consider domperidone in exceptional circumstances, when it is the only effective option, and in line with safety guidance.If gastroparesis is suspected, we should consider referral to specialist services if the diagnosis is uncertain or vomiting is persistent or severe.For painful diabetic peripheral neuropathy, we should follow the relevant guideline.If someone loses their warning signs of hypoglycaemia, we should think about autonomic dysfunction.We should also consider autonomic involvement of the gut in unexplained nocturnal diarrhoea.If someone has autonomic neuropathy, we should be aware that orthostatic hypotension is more likely when taking antihypertensive medication.If someone has unexplained bladder emptying problems, we should investigate possible autonomic neuropathy affecting the bladder.Management should focus on the symptoms present, for example interventions for abnormal sweating or nocturnal diarrhoea.For prevention and management of diabetic foot problems, we should follow the diabetic foot problems guideline.As part of the annual review, we should offer to discuss erectile dysfunction when relevant, including addressing contributory factors such as cardiovascular disease and discussing treatment options.We should consider a phosphodiesterase 5 inhibitor and initially choose the option with the lowest acquisition cost, taking contraindications into account.If treatment is unsuccessful, we should refer to services that can offer other medical, surgical, or psychological options.In terms of eye disease, at diagnosis, we should refer adults immediately to the local eye screening service and encourage regular attendance.We should arrange emergency ophthalmology review for sudden loss of vision, rubeosis iridis, pre retinal or vitreous haemorrhage, or retinal detachment.We should refer to ophthalmology in line with diabetic eye screening pathway standards, and follow the diabetic retinopathy guideline.In this guideline, the recommendations on diagnosing and managing hypertension have been removed. For hypertension in people with type 2 diabetes, we should follow the hypertension in adults guideline, because management is broadly the same as for other people unless specified otherwise.Finally, we should not offer antiplatelet therapy, such as aspirin or clopidogrel, for people with type 2 diabetes who do not have cardiovascular disease.For primary and secondary prevention of cardiovascular disease, we should follow the relevant cardiovascular disease and acute coronary syndromes guidelines.So that is it, a review of a section of the NICE guideline on type 2 diabetes.We have come to the end of this episode. Remember that this is not medical advice but only my summary and my interpretation of the guidelines. You must always use your clinical judgement.Thank you for listening and goodbye.
