Case by case: Type 2 diabetes management

The management of type 2 diabetes has moved beyond a narrow focus on lowering blood glucose. Recently updated NICE guidance places greater emphasis on individualised treatment and the early use of therapies that can protect the heart and kidneys, alongside effective glycaemic control. This has important implications for primary care nurses, who play a central role in diabetes reviews, treatment monitoring, patient education and identifying opportunities to optimise care.

Through three practical case scenarios, this module explores how current guidance can be applied to patients with different clinical priorities: newly diagnosed type 2 diabetes in the presence of established atherosclerotic cardiovascular disease; deteriorating glycaemic control in a patient with chronic kidney disease and hypoglycaemia risk; and the potential role of SGLT-2 inhibitors in a patient with heart failure whose HbA1c is already at target. The cases highlight treatment selection, cardiorenal protection, medication safety, monitoring and effective patient counselling.

This module will support nurses in primary care to:

• Apply current NICE guidance to the initial and ongoing management of adults with type 2 diabetes and cardiovascular or renal comorbidities.
• Explain how metformin, SGLT-2 inhibitors and GLP-1 receptor agonists may be used to support glycaemic control and cardiorenal protection.
• Identify when existing diabetes treatment should be reviewed because of chronic kidney disease, hypoglycaemia risk or changing clinical circumstances.
• Recognise opportunities to consider SGLT-2 inhibitor therapy for cardiovascular and renal benefit, even when HbA1c is already at target.
• Provide appropriate monitoring, safety counselling and sick-day guidance for patients receiving commonly used glucose-lowering therapies.

Author: Molly Mckeown is a diabetes advanced nurse practitioner at North Uttlesford PCN and Diabetes Specialist Nurse Forum Affiliate

Date published: 20.07.2026