Using insulin to manage type 2 diabetes

Type 2 diabetes accounts for approximately 90% of the total UK diabetes population of around 4.3 million people, and this number is set to exceed 5.5 million by 2030 (Wicher et al, 2020; Diabetes UK, 2023). Most diabetes care occurs in general practice, where an average 20 million diabetes contacts occur annually (Dambha-Miller et al, 2020). This places nurses at the centre of type 2 diabetes management in primary care.

The updated National Institute for Health and Care Excellence (NICE) guideline on type 2 diabetes in adults (NG28) recommends offering treatment on an individual basis, taking into consideration factors such as comorbidities, contraindications, symptomatic hyperglycaemia, and weight (NICE, 2022). A combination of lifestyle advice and drug treatment is the corner stone of type 2 diabetes management, and so nurses need to be familiar with these.

The pharmacological pathway in the NICE guidelines on T2DM (NG28) is metformin as first line, or a choice of sulfonylurea (SU), pioglitazone, DPP-4 inhibitor, or SGLT-2 inhibitor if metformin not tolerated or contraindicated (NICE, 2022). These three classes of drugs can also be added as second line therapy if the individual's target HbA1c is not achieved. If dual therapy is not achieved with a combination of two drugs, then a third agent is to be added, including a GLP-1 receptor agonist and insulin (NICE, 2022).