I recently joined an online update session hosted by NICE with brilliant guest speakers — Dr John Patterson, Dr Waqaar Shaw, Sharon McCarthy, and Anthony Walker. They shared some helpful insights, and below I’ve pulled together a friendly summary of the key points that stood out to me.

I would absolutely recommend taking a look at the full, updated guidelines when you get a moment — there are some incredibly helpful tables that make decision‑making in clinical practice much easier. These are found on the tools and resources page on the NG 28 website.  

A stronger focus on truly individualised care

The panel really highlighted that the changes suggested by NICE should be introduced at the person with type 2 diabetes next review and are not intended to add enormously to everyone's workloads. Making the transition smooth and manageable for both healthcare professionals and patients.

A stronger focus on real individualised care

Individualised care is a key principle of nursing practise and the new guidelines really encourage us to focus on this and consider especially; 

• each person’s individual circumstances and preferences
• whether their current medications are still appropriate, effective 
• also any disabilities, especially visual impairments, that could influence their ability to manage their diabetes safely.

Setting targets together

HbA1c targets haven’t changed, but the approach to setting them has. NICE now encourages a much more collaborative, person‑centred style of target‑setting. Instead of telling someone what their target should be, we are encouraged to agree goals together. This helps people feel more engaged, empowered, and supported.

A big change: dual therapy right from diagnosis

One of the biggest updates is around first‑line medication for people newly diagnosed with type 2 diabetes. The new recommendation is to start with:

• Modified‑release metformin
• An SGLT2 inhibitor.

If someone is already taking and tolerating standard metformin, there’s no need to switch them to modified‑release — this applies mainly to new diagnoses. This initial combination aims to support overall health and reduce long‑term risks, thanks to the heart and kidney‑protective benefits of SGLT2 inhibitors.

Supporting younger adults with early-onset type 2 diabetes

For people diagnosed under the age of 40, the guidelines suggest considering:

• Modified‑release metformin
• SGLT2 inhibitors
• Earlier introduction of GLP‑1 receptor agonists.

Education still at the heart of good care

Structured education remains essential. NICE continues to highlight the importance of offering education right from diagnosis and signposting people to trusted resources.

These NG28 updates support personalised care, shared decision‑making, early protection of long‑term health, and education. 

Read the full guidelines: Type 2 diabetes in adults: management