When I first started working in diabetes, things looked very different. I remember testing urine for glucose before blood glucose monitoring became routine. I remember the excitement when BM sticks became more widely available, allowing us to gain a much clearer picture of glucose control. Insulin syringes were larger, treatment options were fewer, and many of our conversations focused primarily on blood glucose levels.
Over the years, I’ve witnessed remarkable changes in diabetes care. We’ve seen the introduction of insulin analogues, the rise of structured education programmes, advances in glucose monitoring technology, and the arrival of therapies that not only lower glucose but also offer cardiovascular, renal and weight-management benefits.
I’ve also seen treatments that once generated enormous excitement later prompt us to ask important questions. Many healthcare professionals will remember rosiglitazone. At one time it was viewed as a significant advance in type 2 diabetes management and was widely prescribed. However, concerns emerged regarding cardiovascular safety, leading to increased scrutiny of diabetes therapies and ultimately changing the way new medications are evaluated.
In many ways, this marked a turning point in diabetes care. Regulatory authorities began requiring robust cardiovascular outcome trials (CVOTs) for newer glucose-lowering therapies to demonstrate cardiovascular safety. What followed was something few of us anticipated. Rather than simply proving these medications were safe, many studies revealed benefits extending far beyond glucose lowering, including reductions in cardiovascular events, heart failure hospitalisations and progression of kidney disease.
The cardiovascular and renal protection that now feature so prominently in diabetes guidelines are, in part, the result of lessons learned from the past. It is a powerful reminder that diabetes care never stands still. As evidence evolves, so too must our practice.
Few developments illustrate that ongoing evolution more clearly than the latest updates to NICE guidance [NG28]: Type 2 diabetes in adults: management.
For healthcare professionals, keeping up with these changes can feel challenging. New evidence continues to emerge, treatment pathways evolve, and recommendations are updated. At the same time, clinicians are managing increasingly complex patient populations and balancing multiple competing priorities within busy services.
It’s perhaps no surprise that many healthcare professionals are asking the same question:
“What do I actually need to know for my day-to-day practice?”
For many years, diabetes management centred largely on achieving glycaemic targets. Whilst blood glucose control remains important, our understanding of type 2 diabetes has changed significantly.
We now recognise that cardiovascular disease, heart failure and chronic kidney disease contribute substantially to morbidity and mortality in people living with type 2 diabetes. As a result, treatment decisions increasingly consider the wider health benefits of therapies rather than focusing solely on HbA1c reduction.
This shift represents one of the most important changes in modern diabetes care.
Today’s clinicians are often considering questions such as:
These questions are increasingly shaping everyday practice.
Few medication classes have changed the diabetes landscape quite as dramatically as SGLT2 inhibitors.
Originally introduced as glucose-lowering medications, growing evidence has demonstrated important benefits for cardiovascular and renal outcomes. As a result, their role within diabetes management has expanded considerably.
For many clinicians, this feels like another major shift in thinking. We are no longer simply asking, “How much will this lower HbA1c?” We are also considering how treatments may help protect the heart, preserve kidney function and improve long-term outcomes.
This has understandably generated plenty of discussion amongst healthcare professionals.
Questions I am frequently asked include:
These are exactly the sorts of questions that many clinicians are currently exploring as they become familiar with the latest guidance.
Of course, SGLT2 inhibitors are only one part of the story.
Over the last decade, we’ve also seen significant advances in incretin-based therapies. GLP-1 receptor agonists have transformed the treatment landscape, offering benefits that extend beyond glucose lowering alone. For many people living with type 2 diabetes, these therapies can support weight management whilst also contributing to improved glycaemic control and cardiovascular outcomes.
The pace of change shows no sign of slowing. The emergence of dual agonists and other novel therapies is further reshaping our expectations of what can be achieved in the management of type 2 diabetes and obesity.
For healthcare professionals, this creates exciting opportunities but also new challenges. Understanding where these therapies fit within current treatment pathways, identifying which individuals are most likely to benefit, and keeping pace with an evolving evidence base can feel daunting.
As treatment options continue to expand, it becomes increasingly important to understand not only what is available today, but also where diabetes management may be heading in the future.
One thing that has remained constant throughout my career is that no two people living with diabetes are the same.
Guidelines provide an important framework, but effective diabetes care requires us to look beyond algorithms and consider the individual. Their priorities, preferences, co-morbidities, lifestyle and personal goals all influence treatment decisions.
As our therapeutic options increase, so does the importance of shared decision-making.
The challenge for healthcare professionals is translating increasingly complex evidence into practical, meaningful conversations that support people to make informed choices about their care.
The latest NICE updates are more than simply changes to a treatment algorithm.
They reflect a broader shift in how we think about type 2 diabetes and the outcomes that matter most to the people living with it.
For clinicians who haven’t yet had time to work through every page of the updated guidance, understanding the key messages can feel daunting. Yet these changes have important implications for prescribing decisions, patient reviews and routine clinical practice.
When I started in diabetes, our conversations were largely about glucose. Today we’re discussing cardiovascular protection, kidney protection, obesity management, continuous glucose monitoring, GLP-1 receptor agonists, dual agonists and therapies that would have seemed unimaginable when I first entered practice.
It’s an exciting time to work in diabetes, but it can also feel difficult to keep up.
The challenge isn’t keeping up with every research paper that gets published. It’s understanding what has changed, why it has changed, and what we should be doing differently when we see our next patient.
If you’ve heard that the NICE guidance has changed but haven’t had time to explore the detail, this session is designed for you.
During this practical lunchtime update, we’ll discuss:
Whether you’re new to diabetes care or have worked in the field for many years, this session aims to provide a clear, concise and clinically relevant update that you can take straight back into practice.
Having worked through decades of change in diabetes care, one thing I know for certain is that learning never stops. The latest NICE guidance is another important step in an ongoing journey, and I look forward to helping you translate those changes into practical, confident clinical decisions during this lunchtime update.
To register your place for this update please visit our sign up page here.
Sonia Willis RGN
BA Hons, PG Certs, Nurse Prescriber
Independent Nurse Specialist in Diabetes Management and Education
Looking to build confidence across your primary care team? Health Academy offers practical diabetes training, including our 5* rated Foundations of Diabetes for HCAs course written and developed by Sonia Willis. You can explore our diabetes courses, register your interest, or get in touch with us to discuss a bespoke training quote for your organisation.
Our ‘Foundations of Diabetes’ course provides HCAs with the essential knowledge and skills needed to effectively support the management of patients with diabetes in primary care settings.
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