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Reference Point

Type 2 Diabetes

A clinical reference for UK primary care

Last reviewed 28 April 2026 · Next review July 2026

Type 2 diabetes management has shifted considerably. Cardiovascular and renal protection now sit alongside glycaemic control as primary targets, and the threshold for early intensive intervention has moved earlier in the patient journey.¹

Around 4.6 million people in the UK live with diabetes, with type 2 making up roughly 90%.³

Prevalence continues to climb, with a notable rise in adults under 40.³

Latest Analysis

Recent in type 2 diabetes

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8 Jun 2026

NG28 NICE GUIDELINES: The Flozin-First Era, and 810,000 More GLP-1 Patients

28 Apr 2026

FreeDM2: Real-time CGM for type 2 diabetes on basal insulin.

2 Apr 2026

GLP-1 for Alzheimer's? EVOKE trial says no

13 Mar 2026

GLP-1 Receptor Agonists: Mechanism of Action

11 Mar 2026

SGLT2i vs GLP-1 RA: which one offers more kidney protection?

22 Feb 2026

MHRA Safety Update: Semaglutide and the Risk of Rare Vision Loss

5 Feb 2026

The GLP-1 revolution: the good, the bad and the ugly

31 Jul 2026

BMI and type 2 diabetes: how much do ethnicity, age, and sex matter?

16 Jun 2026

REIMAGINE-2: how effective is combination therapy for type 2 diabetes?

12 Jun 2026

The phase 3 diabetes endpoint for retatrutide has been met, as shown by TRANSCEND-T2D-1

9 Jun 2026

ACHIEVE-5 phase 3 trial shows superiority of GLP-1 RA alongside basal insulin

17 May 2026

ACHIEVE-4: what the mortality signal actually tells UK clinicians

Diagnosis

Diagnostic criteria

Four diagnostic routes accepted by NICE, based on WHO criteria.^2,4

HbA1c

≥48 mmol/mol (6.5%)

One result diagnostic if symptomatic. Two needed if asymptomatic.^2,4

Fasting plasma glucose

≥7.0 mmol/L

No caloric intake for at least 8 hours.^2,4

2-hour OGTT plasma glucose

≥11.1 mmol/L

After 75g oral glucose load.^2,4

Random plasma glucose

≥11.1 mmol/L

With classical hyperglycaemic symptoms.^2,4

WHEN HBA1C SHOULD NOT BE USED

Children, pregnancy, suspected type 1 diabetes, symptoms under two months, recent pancreatic damage or surgery, end-stage CKD, HIV, or any condition affecting red cell turnover including haemoglobinopathies and recent transfusion.^2,4

Risk Stratification

Validated tools used in primary care

CARDIOVASCULAR

QRISK3

10-year risk of MI or stroke. The standard CV risk tool in UK primary care.⁵

RENAL

Kidney Failure Risk Equation

2 and 5-year risk of kidney failure. Now in NG203, with a 5-year risk over 5% triggering renal referral.^6,7

FOOT

Diabetic foot risk stratification

Annual stratification into low, moderate or high risk. Determines screening interval and foot protection service involvement.⁸

RETINAL

National diabetic eye screening

Offered annually from age 12. Some areas now use extended intervals for consistently low-risk patients.⁹

Ongoing Review

The annual care processes

The nine annual checks measured by the National Diabetes Audit.¹⁰

National Diabetes Audit

Track completion of all nine care processes for your practice

HbA1c

Glycaemic control

Blood pressure

Cardiovascular risk

Cholesterol

Full lipid profile

Serum creatinine

eGFR

Urine ACR

Renal screening

Foot examination

Annual risk assessment

BMI

Weight assessment

Smoking status

Cessation support

Retinal screening

National programme

Referral pathways

Specialist diabetes

Suspected type 1 or monogenic diabetes. Complex needs. Persistent HbA1c above target despite optimised primary care.¹

Renal

Per NG203: 5-year KFRE >5%, eGFR <30 mL/min/1.73m², or rapidly declining eGFR.⁶

Foot protection

Moderate or high foot risk on annual review. Active ulceration or limb-threatening features warrant same-day MDT referral.⁸

Pre-conception

Women of reproductive age planning pregnancy, per NG3.¹¹

Mental health

Depression and anxiety are more common in adults with diabetes. Screen routinely and refer when indicated.¹

Find all NICE updates relevant to primary care

View NICE Guidelines

This disease hub is intended for UK Healthcare Professionals only. Content reports established clinical knowledge and current NICE guidance. It is not a substitute for clinical judgment or for the original guidelines. Last reviewed 28 April 2026.

References

All sources verified at last review. Where primary literature is cited, original peer-reviewed publications are linked.