Diabetes & Primary Care’s series of interactive case studies is aimed at all healthcare professionals in primary and community care who would like to broaden their understanding of diabetes.
These four scenarios review the add-on therapies recommended in the NICE NG28 guideline when initial therapies for type 2 diabetes do not achieve HbA1c targets.
The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.
Working through the case studies will improve our knowledge and problem-solving skills in diabetes care by encouraging us to make evidence-based decisions in the context of individual cases.
Readers are invited to respond to the questions by typing in their answers. In this way, we are actively involved in the learning process, which is hopefully a much more effective way to learn.
By actively engaging with these case histories, readers will feel more confident and empowered to manage such presentations effectively in the future.
Sami has type 2 diabetes, diagnosed 2 years ago. His HbA1c is above target despite taking an SGLT2 inhibitor. He cannot tolerate metformin in any formulation.
What might you offer Sami to improve his glycaemic control?
Linda has type 2 diabetes and has recently developed angina. She is taking modified-release metformin and dapagliflozin.
What could you offer to improve glycaemic control and provide additional cardiovascular protection?
Arthur is living with obesity and type 2 diabetes. His HbA1c is above target despite treatment with metformin and dapagliflozin.
What would be your next choice of glucose-lowering medication?
Sunila has type 2 diabetes and chronic kidney disease, treated with metformin and dapagliflozin. Her eGFR has fallen to 27 mL/min/1.73 m2.
What medication change is now needed?
By working through this interactive case study, we will review the additional glucose-lowering therapies recommended by NICE when initial therapy does not achieve HbA1c targets.
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9 Aug 2026