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One of the most prevalent conditions in the RCGP clinical topic guide ‘Metabolic problems and endocrinology’ is type 2 diabetes. This course includes the 2026 updates to the management of type 2 diabetes, explaining why our prescribing habits need to change and how patients will benefit as a result. In 2026, NICE made a significant update to its guidance on the management of type 2 diabetes. For many years, the mainstay of treatment for diabetes has been metformin, whereas the new guidance recommends the initiation of a sodium-glucose co-transporter 2 inhibitor – SLGT-2i or ‘flozin’ – alongside metformin, from the start of treatment. This brings the NICE guidance closer to the joint American Diabetic Association (ADA) and European Association for the Study of Diabetes (EASD) guidelines which were published in 2022. This coincided with dapagliflozin becoming available in generic form, with potential savings to the NHS of £560m over two years. This course looks at the most recent up to date approach to diabetes, reflecting new and updated recommendations on metformin, SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas and pioglitazone. The renal and cardiovascular protective benefits of SGLT-2 inhibitors are particularly considered, along with specific areas for caution and advice on patient counselling. In recognition of the recommendation for joint initial therapy, intervention for escalation is no longer referred to by the number of drugs the patient is on, instead referring to initial regimes and subsequent changes. Furthermore, the guideline networks with NICE guidance on overweight and obesity management and the recommendations for the NHS type 2 diabetes Path to Remission programme. Completion of the course will give you a deeper understanding of when to initiate glucose-lowering therapy, how to make personalised choices for patients, and the particular benefits of various drug classes. You will appreciate when aggressive glucose reduction strategies may be needed and how to approach these, as well as being able to engage in shared decision making with patients and carers about deprescribing. The latter is particularly important with an ageing population and rising frailty, but in the context of contractual encouragement to achieve nationally-set HbA1c targets. This course falls within the 'Metabolic problems and endocrinology' curriculum field. Production, editorial, and distribution owned by the Royal College of General Practitioners.
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