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Related Concept Videos

Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

Oral Hypoglycemic Agents: Biguanides and Glitazones

Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood glucose levels...
Diabetes Mellitus: Type 2 and Gestational01:22

Diabetes Mellitus: Type 2 and Gestational

Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
Dipeptidyl Peptidase 4 Inhibitors01:23

Dipeptidyl Peptidase 4 Inhibitors

Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a significant...
Oral Hypoglycemic Agents: Glinides01:06

Oral Hypoglycemic Agents: Glinides

Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...
Glucagon-like Receptor Agonists01:24

Glucagon-like Receptor Agonists

Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...

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Related Experiment Videos

Implementing SGLT2 Inhibitor Therapy in Line with the New NICE Guidelines for Type 2 Diabetes Management.

Philip Newland-Jones1,2, Partha Kar3, Beth Kelly4

  • 1University Hospitals Southampton NHS Foundation Trust, Southampton, UK.

Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders
|July 13, 2026
PubMed
Summary

New UK guidelines prefer sodium-glucose cotransporter-2 inhibitors (SGLT2is) for type 2 diabetes mellitus (T2DM) management. Despite evidence, SGLT2is are under-prescribed, highlighting a gap between recommendations and practice.

Keywords:
Cardiovascular, renal and metabolic protectionGlycaemic optimisationOral glucose-lowering medicinesSGLT2isSodium–glucose cotransporter-2 inhibitorsType 2 diabetes mellitus

Related Experiment Videos

Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Nephrology

Background:

  • The UK National Institute for Health and Care Excellence (NICE) guideline NG28 now recommends sodium-glucose cotransporter-2 inhibitors (SGLT2is) as preferred first-line therapy for type 2 diabetes mellitus (T2DM).
  • Previous guidelines restricted SGLT2i use to specific patient groups with high cardiovascular disease (CVD) risk or existing CVD/kidney disease.
  • This shift aligns UK recommendations with international standards for managing glycaemic control and reducing cardiovascular, renal, and metabolic (CVRM) complications.

Purpose of the Study:

  • To examine the role of SGLT2is within the updated NICE NG28 guidelines.
  • To identify reasons for the suboptimal real-world prescription of SGLT2is.
  • To provide practical guidance for initiating and managing SGLT2is in T2DM patients.

Main Methods:

  • Narrative review of current literature and guidelines.
  • Analysis of prescribing data and clinical practice trends.
  • Development and update of a practical SGLT2i Prescribing Decision Tool.

Main Results:

  • SGLT2is are now a preferred first-line therapy for T2DM, offering benefits beyond glycaemic control.
  • Real-world data indicate under-prescription of SGLT2is, particularly in high-risk populations.
  • A gap exists between guideline recommendations and clinical practice regarding SGLT2i initiation.

Conclusions:

  • The updated NICE guidelines emphasize the broad benefits of SGLT2is for T2DM management.
  • Addressing barriers to SGLT2i prescription is crucial to optimize patient outcomes.
  • Practical tools and clear guidance can support healthcare professionals in appropriate SGLT2i use.