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Primary Care Guidelines

Primary Care Guidelines

By: Juan Fernando Florido Santana
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A podcast intended for healthcare professionals wanting to keep up to date relevant information about clinical practice guidelines

All rights reserved. Hygiene & Healthy Living Physical Illness & Disease
Episodes
  • Podcast - NICE 2026 Type 2 Diabetes Guideline – Part 4: Introducing Medicines and Treatment Escalation

    Podcast - NICE 2026 Type 2 Diabetes Guideline – Part 4: Introducing Medicines and Treatment Escalation
    Apr 15 2026
    The video version of this podcast can be found here: · https://youtu.be/dp6d3yH7AJsThis episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I review the NICE guideline on Type 2 diabetes in adults: management, always focusing on what is relevant in Primary Care only.I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido. Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The NICE clinical guideline on Type 2 diabetes in adults: management [NG28] can be found here: · https://www.nice.org.uk/guidance/ng28TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I’m Fernando, a GP in the UK. Today we are looking at the new updated NICE guideline on type 2 diabetes in adults, always focusing on what is relevant in Primary Care only.The diabetes guideline is a comprehensive document, so I am breaking it down into clear and practical sections.Today, we are focusing on how to introduce medicines, how to review them, and what to do when further treatment is needed after the initial regimen.In recent episodes, we covered the earlier sections of the guideline. In future episodes, we will move on to insulin-based treatment in more detail and the management of complications.Right, let’s jump into it.First, let’s look at introducing medicines.We should introduce medicines one at a time and check tolerability and effectiveness before moving on.When starting initial therapy with modified release metformin and other medicines, we should begin with metformin and confirm it is tolerated.If we are using an SGLT 2 inhibitor, we should start it once metformin is at the maximum tolerated dose.If we are also planning to use a GLP 1 receptor agonist or tirzepatide, we should introduce this once the SGLT 2 inhibitor is at the maximum tolerated dose.So even though the initial plan may involve more than one medicine, we still introduce them sequentially one at a time and monitor carefully.Now, let’s look at preventing diabetic ketoacidosis with SGLT 2 inhibitors.Before starting an SGLT 2 inhibitor, we should assess the risk of DKA.Risk factors include a previous episode of DKA, acute illness, dehydration, or following a very low carbohydrate or ketogenic diet.We should address modifiable risks before starting treatment. For example, if someone is on ...
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    7 mins
  • Podcast - NICE News - March 2026

    Podcast - NICE News - March 2026
    Apr 8 2026
    The video version of this podcast can be found here: · https://youtu.be/-kla7F8yibMThis episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through new and updated recommendations published in March 2026 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido. Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulletin for February 2026 can be found here: · https://www.nice.org.uk/guidance/published?from=2026-03-01&to=2026-03-31&ndt=Guidance&ndt=Quality+standardThe new guideline on Kidney cancer: diagnosis and management [NG256] can be found here:· https://www.nice.org.uk/guidance/ng256The guideline on suspected cancer: recognition and referral can be found here:· https://www.nice.org.uk/guidance/ng12/TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome! I’m Fernando, a GP in the UK. In today’s episode, we’ll look at the NICE updates published in March 2026, focusing on what is relevant in Primary Care only. This month, none of the updated guidelines were relevant to primary care. Only one new guideline had some relevance: kidney cancer: diagnosis and management.We will cover this briefly, focusing mainly on diagnosis and referring to the relevant section of the NICE guideline on suspected cancer, recognition and referral.Right, let’s jump into it.Before we go into kidney cancer itself, let’s briefly set the scene by looking at the NICE suspected cancer guideline. It is designed to help us recognise when symptoms may represent cancer and when to refer patients urgently.In urological cancers, we need to be aware that many cancers, including kidney and bladder cancer, may present with relatively non-specific symptoms.However, one symptom stands out as particularly important: that is, haematuria.Visible haematuria is the single most important red flag symptom for urological cancers.NICE recommends that we should make an urgent suspected cancer referral for bladder or renal cancer in adults aged 45 and over with unexplained visible haematuria, either without a urinary tract infection, or if it persists or recurs after treatment of a urinary tract ...
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    6 mins
  • Podcast - NICE 2026 Type 2 Diabetes Guideline – Part 3: Medicines Management and Initial Treatment

    Podcast - NICE 2026 Type 2 Diabetes Guideline – Part 3: Medicines Management and Initial Treatment
    Apr 1 2026
    The video version of this podcast can be found here: · https://youtu.be/7LiKkriN9tcThis episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I review the NICE guideline on Type 2 diabetes in adults: management, always focusing on what is relevant in Primary Care only.I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido. Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The NICE clinical guideline on Type 2 diabetes in adults: management [NG28] can be found here: · https://www.nice.org.uk/guidance/ng28 TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I’m Fernando, a GP in the UK. Today we are looking at the new updated NICE guideline on type 2 diabetes in adults, always focusing on what is relevant in Primary Care only. The diabetes guideline is a comprehensive document, so I am breaking it down into clear and practical sections.Today, we are focusing on medicines management, including sick day rules and choosing initial medicines.In recent episodes, we covered the initial sections of the guideline and in future episodes, we will move on to further drug treatment and the management of complications.Right, let’s jump into it.When discussing medicines, we should go through the benefits and risks of each option. This includes:· The effect on HbA1c and weight.· The effect on cardiovascular and renal outcomes.· Whether there are contraindications, such as pioglitazone in heart failure or metformin when eGFR is below 30.· Practical issues that might affect adherence.· And cost. If two medicines from the same class are equally suitable, we should use the least expensive option.If a person has more than one comorbidity, for example atherosclerotic cardiovascular disease and obesity, we should make a shared decision about which condition to prioritise. When discussing GLP 1 receptor agonists or tirzepatide we should explain the guidance on use in pregnancy and breastfeeding. We should explain that weight loss may improve fertility and that effective contraception must be used while taking these medicines. And if pregnancy is planned, contraception should continue for a period after stopping treatment.Now let’s move on to sick day rules.We should include clear sick ...
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    7 mins
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