Adapted from BMJ 18 June 2022: Type 2 diabetes: summary of updated NICE guidance
When type 2 patients eventually get their diabetes checks, they can expect a few changes to management if their practices are keeping up with NICE guidelines.
Instead of looking at the 10 year risk for cardiovascular disease, type 2 diabetics over the age of 40 will be assessed for lifetime risk. This is usually a pathway to the initiation of statins, if they are not already being taken. If the cardiovascular risk is raised you will also be considered for an SGLT inhibitor.
If you have chronic heart failure or have already been diagnosed with atherosclerosis you will be considered for an SGLT2 inhibitor. These give a proven cardiovascular benefit.
SGLT2 inhibitors work well with Metformin if a glucose lowering drug is needed.
Modifiable risk factors for diabetic ketoacidosis should be assessed before prescribing SGLT2 inhibitors.
Such factors are: Alcohol limit above 14 units a week, use of illegal drugs, use of other medicines, concurrent illness, injury or planned surgery, very low carbohydrate or ketogenic diet.
There is a decision aid available at:
Diabetes Diet 
My nephrologist said he is prescribing SGLT2 inhibitors for T1’s who are classified as having stage 3b kidney disease. after 47 years I am at stage 3a and of course there is a ways to go to get to 3b. But given where I am, and family history I am fairly sure he was bracing me for the inevitable. But as he said, after 47 years you have to say this has worked out pretty good. OK, well if he says so.
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