Ten-minute consult

1. A 54-year-old man is diagnosed with type 2 diabetes after two HbA1c results of 54 and 56 mmol/mol. BMI is 29.0 kg/m2. Blood pressure, lipids, eGFR and urine ACR are normal. There is no heart failure, atherosclerotic cardiovascular disease or clinically significant frailty. He can swallow tablets. What is the most appropriate initial glucose-lowering regimen according to current NICE NG28 (2026)?

2. A 58-year-old man with newly diagnosed type 2 diabetes has eGFR 41 mL/min/1.73 m2 and previous severe gastrointestinal intolerance to metformin (both standard and modified-release). There is no frailty that would make an SGLT-2 inhibitor unsafe. What is the most appropriate initial glucose-lowering medicine? The most appropriate action is: An SGLT-2 inhibitor as monotherapy

3. A 72-year-old woman with type 2 diabetes has eGFR 28 mL/min/1.73 m2. She is not on metformin. A QOF-style dashboard still prompts add metformin. Which statement about metformin is correct? Select TWO correct statements.

Select all that apply.

4. A 49-year-old man has taken standard-release metformin 1 g twice daily for 4 years with no gastrointestinal adverse effects. HbA1c is at his agreed target. NG28 has been updated. What is the most appropriate advice about metformin formulation? The most appropriate action is: He may continue standard-release metformin if it remains effective and tolerated

5. A 78-year-old woman with dementia and dysphagia needs metformin for type 2 diabetes. The care home protocol is to crush all tablets into jam, including modified-release brands. Which formulation is most appropriate?

6. A 36-year-old woman is diagnosed with type 2 diabetes (onset under 40 years). BMI 34 kg/m2. No atherosclerotic cardiovascular disease, heart failure or significant frailty. What additional consideration does NG28 (2026) make beyond modified-release metformin and an SGLT-2 inhibitor? Select TWO correct statements.

Select all that apply.

7. A 70-year-old man with type 2 diabetes, heart failure with reduced ejection fraction, and CKD G3a A2 has taken dapagliflozin for 18 months. HbA1c is 58 mmol/mol on an agreed relaxed target and has not fallen further. He is euvolaemic and has had no DKA. What is the most appropriate action regarding the SGLT-2 inhibitor? Select TWO correct statements.

Select all that apply.

8. A 89-year-old woman with type 2 diabetes lives in a care home. She has recurrent postural hypotension, previous falls, and clinically significant frailty. HbA1c is 62 mmol/mol. eGFR 52. A trainee suggests starting modified-release metformin and empagliflozin together today, citing NG28 dual therapy for all adults. What is the most appropriate plan?

9. A 64-year-old man with new type 2 diabetes and known atherosclerotic cardiovascular disease attends a 10-minute new-patient slot. You plan NG28 triple therapy. What is the most appropriate practical initiation strategy?

10. A 45-year-old woman with type 2 diabetes and obesity (BMI 38 kg/m2) has been titrated on modified-release metformin and an SGLT-2 inhibitor. There is no atherosclerotic cardiovascular disease or early-onset diagnosis. Agreed HbA1c remains above target. What does NG28 (2026) say about the next glucose-lowering step?