Podcast - NICE 2026 Type 2 Diabetes Guideline – Part 1: Education, Lifestyle and Bariatric Surgery
7m | Mar 18, 2026The video version of this podcast can be found here:
· https://youtu.be/y-hTBUYkInk
This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.
NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.
My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I review the NICE guideline on Type 2 diabetes in adults: management, always focusing on what is relevant in Primary Care only.
I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.
Disclaimer:
The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions.
In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido.
Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]
- Music provided by Audio Library Plus
- Watch: https://youtu.be/aBGk6aJM3IU
- Free Download / Stream: https://alplus.io/halfway-through
There is a podcast version of this and other videos that you can access here:
Primary Care guidelines podcast:
· Redcircle: https://redcircle.com/shows/primary-care-guidelines
· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK
· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148
There is a YouTube version of this and other videos that you can access here:
- The Practical GP YouTube Channel:
https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk
The NICE clinical guideline on Type 2 diabetes in adults: management [NG28] can be found here:
· https://www.nice.org.uk/guidance/ng28
Transcript
If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.
Hello and welcome, I’m Fernando, a GP in the UK. Today we are looking at the new updated NICE guideline on type 2 diabetes in adults, always focusing on what is relevant in Primary Care only.
The link to the NICE guideline is the episode description.
Right, let’s jump into it.
The diabetes guideline is a comprehensive document, so I am going to break it down into manageable sections.
Today, we will focus on the first part of the NICE guideline, covering tailoring care, structured education, dietary advice, and bariatric surgery.
In future episodes, we will move on to drug treatment and the management of complications.
First, let’s start with tailoring care to the person.
NICE recommends an individualised approach for adults with type 2 diabetes. Care should be tailored to the person’s needs and circumstances. This includes their personal preferences, their other medical conditions, the risks from polypharmacy, and their likelihood of benefiting from long term treatments.
This is especially important for people with multimorbidity. At each review, we should reassess the person’s situation and think about whether any medicines are no longer effective and could be stopped.
When planning care, we should take into account any disabilities, including visual impairment.
For discussions about overweight and obesity, NICE directs us to the guideline on overweight and obesity management, including how to classify overweight and obesity and how to address the drivers behind it. There is also a specific section in the guideline on eating disorders for those who have both type 2 diabetes and an eating disorder, covering advice on collaborative care, blood glucose management, and insulin use.
Next is structured education.
NICE says we should offer structured education to all adults with type 2 diabetes at diagnosis. Family members or carers should also be involved where appropriate. Education should be reinforced and reviewed every year and it should be explained clearly that structured education is a core part of diabetes care.
Education programmes should be evidence based and suitable for the person. They should have clear aims and learning objectives, and support people to develop the knowledge and skills to self-manage their diabetes.
Programmes should follow a structured curriculum, be delivered by trained educators, and outcomes should be regularly monitored.
Group education is the preferred option, but there must be an alternative of equal standard for people who cannot attend or prefer not to take part in group sessions.
Education programmes should meet local cultural, language, cognitive and literacy needs. All members of the diabetes team should know what programmes are available locally, and these programmes should be integrated into the overall care pathway.
Now let’s move on to dietary advice.
Adults with type 2 diabetes should receive individualised and ongoing nutritional advice from a healthcare professional with expertise in nutrition.
Dietary advice should be sensitive to the person’s culture, beliefs, willingness to change, and the impact on quality of life.
In general, people with type 2 diabetes should follow the same healthy eating advice as the general population. This includes choosing high fibre, low glycaemic index carbohydrates such as fruit, vegetables, wholegrains and pulses, choosing low fat dairy products, eating oily fish, and limiting saturated and trans fats.
For low energy or very low energy diets aimed at remission, the guideline directs us to the specific guidance on the NHS Type 2 Diabetes Path to Remission Programme and the overweight and obesity management guideline.
Dietary advice should be integrated into a personalised diabetes management plan, including physical activity and weight management.
Carbohydrate intake, alcohol intake, and meal patterns should be individualised. Reducing the risk of hypoglycaemia is particularly important for people using insulin or insulin secretagogues.
People can substitute a limited amount of sucrose containing foods for other carbohydrates in their meal plan, but they should avoid excess calorie intake.
NICE advises against using foods marketed specifically for people with diabetes.
For people admitted to hospital or another care setting, there should be a meal planning system that provides consistency in carbohydrate content.
Finally, let’s talk about bariatric surgery.
For people with recent onset type 2 diabetes, we should follow the recommendations on surgical interventions in the overweight and obesity management guideline.
This guideline is separate to the diabetes guideline but we will cover it briefly here. It says that we should offer adults a referral for a comprehensive assessment by a specialist multidisciplinary overweight and obesity management service to see whether bariatric surgery is suitable if they have a BMI of 40 or more, or a BMI between 35 and 39.9 with a significant health condition that could improve with weight loss. These conditions include cardiovascular disease, hypertension, fatty liver disease, obstructive sleep apnoea, and type 2 diabetes. The person must also agree to long term follow up after surgery, including lifelong annual reviews.
For people of South Asian, Chinese, other Asian, Middle Eastern, Black African, or African Caribbean background, we should use a BMI threshold that is 2.5 lower than these values, because cardiometabolic risk occurs at lower BMI in these groups.
We should refer for expedited assessment for bariatric surgery to people with a BMI of 30 or more who have recent onset type 2 diabetes, defined as diagnosed within the past 10 years, provided they are also being assessed within a specialist overweight and obesity management service.
For people from South Asian, Chinese, other Asian, Middle Eastern, Black African, or African Caribbean backgrounds, we should use BMI thresholds that are 2.5 lower when deciding on expedited assessment.
So that is it, a review of the first section of the NICE guideline on type 2 diabetes.
We have come to the end of this episode. Remember that this is not medical advice but only my summary and my interpretation of the guidelines. You must always use your clinical judgement.
Thank you for listening and goodbye.
