Approximately 4.3 million people in the UK have been diagnosed with diabetes, and around 90% of those have type 2, according to Diabetes UK. Community pharmacists dispense diabetes medicines more frequently than almost any other therapeutic class, and they are increasingly involved in structured support beyond dispensing — from new medicine counselling to blood glucose monitoring advice and lifestyle signposting.
This guide covers the practical knowledge pharmacy teams need to support people with type 2 diabetes effectively.
The medicines landscape
Metformin: still first-line
Metformin remains the first-line pharmacological treatment for type 2 diabetes according to NICE NG28, unless contraindicated or not tolerated. Pharmacy teams should be familiar with the key counselling points:
- Take with or after food to reduce gastrointestinal side effects (nausea, diarrhoea, abdominal discomfort), which affect up to 25% of patients.
- Modified-release formulations may be better tolerated. If a patient reports persistent GI symptoms on standard-release metformin, suggest discussing a switch with their prescriber.
- Vitamin B12 monitoring. Long-term metformin use (typically over 3–4 years) can reduce vitamin B12 absorption. NICE recommends annual B12 monitoring for patients on metformin who develop symptoms suggestive of deficiency (fatigue, peripheral neuropathy).
- Sick day rules. Metformin should be temporarily withheld during acute illness involving dehydration, vomiting or diarrhoea due to the risk of lactic acidosis. Pharmacy teams should reinforce this message, particularly during winter illness seasons.
Second-line and newer agents
When metformin alone does not achieve glycaemic targets (typically HbA1c below 48 mmol/mol or 53 mmol/mol depending on individual targets), additional agents are introduced. The pharmacy team encounters a growing range:
| Drug class | Examples | Key pharmacy counselling points |
|---|---|---|
| Sulfonylureas | Gliclazide, glimepiride | Hypoglycaemia risk — ensure patient knows symptoms and carries glucose tablets |
| SGLT2 inhibitors | Dapagliflozin, empagliflozin, canagliflozin | Genital thrush risk (especially in women); DKA risk (rare but serious); hydration advice |
| DPP-4 inhibitors | Sitagliptin, linagliptin, saxagliptin | Generally well tolerated; rare pancreatitis risk |
| GLP-1 receptor agonists | Semaglutide, liraglutide, dulaglutide | Injection technique; nausea management during dose titration; storage (refrigerate before first use) |
| Insulin | Multiple formulations | Injection technique, hypoglycaemia awareness, sharps disposal, storage |
SGLT2 inhibitors have become particularly important since NICE recommended dapagliflozin and empagliflozin for patients with type 2 diabetes and established cardiovascular disease or heart failure, based on the DAPA-HF and EMPEROR-Reduced trials. Pharmacy teams should ensure patients understand the polyuria and genital infection risks that accompany the glycosuric mechanism.
GLP-1 receptor agonists and the weight management crossover
The arrival of semaglutide (Ozempic for diabetes, Wegovy for weight management) has created a complex prescribing landscape. Pharmacy teams should be aware that:
- Ozempic and Wegovy contain the same active ingredient at different doses and for different indications.
- Supply pressures have affected availability, and substitution between diabetes and weight management indications is not appropriate.
- Patients may ask about obtaining GLP-1 agonists for weight loss — pharmacists should direct them to appropriate NHS or NICE-recommended pathways. See: Weight Management and Pharmacy
Blood glucose monitoring
Pharmacy teams frequently advise patients on self-monitoring of blood glucose (SMBG). Key practical points:
Who should self-monitor? NICE recommends SMBG for patients on insulin or sulfonylureas (due to hypoglycaemia risk), during intercurrent illness, and during medication changes. Routine SMBG is not recommended for most patients on metformin alone.
Meter and strip prescribing. The cost of blood glucose test strips varies significantly — from around £5 to over £30 per 50 strips. NICE encourages prescribers to use the most cost-effective meter and strips available. Pharmacy teams can flag cost-saving opportunities if they notice high-cost strips being prescribed where equivalent accuracy is available at lower cost.
Continuous glucose monitoring (CGM). Flash glucose monitoring (FreeStyle Libre) is increasingly prescribed for type 2 diabetes patients on multiple daily insulin injections. Pharmacy teams should understand the basics: sensor application, scanning frequency, and the 60-minute lag between interstitial and capillary glucose readings.
Structured education signposting
NICE recommends that all people newly diagnosed with type 2 diabetes are offered a structured education programme. The two main programmes are:
- DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) — a one-day or half-day group course
- X-PERT Health — a six-week group programme
Uptake remains low nationally — Diabetes UK estimates that fewer than 20% of eligible patients attend. Pharmacists conducting New Medicine Service (NMS) consultations for diabetes medicines have a natural opportunity to check whether the patient has been offered structured education and to encourage attendance.
The pharmacy role in diabetes care
New Medicine Service (NMS)
Diabetes medicines are among the most common NMS-eligible categories. The structured follow-up at 7–14 days and 21–28 days after a new diabetes medicine is initiated provides an ideal opportunity to check:
- Is the patient taking the medicine correctly?
- Are there side effects that need managing?
- Does the patient understand sick day rules?
- Has the patient been referred for structured education?
See: New Medicine Service Explained
Blood pressure and cardiovascular risk
Type 2 diabetes substantially increases cardiovascular risk. NICE recommends a target blood pressure of below 140/80 mmHg (or below 130/80 mmHg for people with kidney disease, eye disease, or cerebrovascular disease). Community pharmacy blood pressure checking services contribute to cardiovascular risk monitoring for people with diabetes.
Foot care awareness
Diabetic foot complications lead to approximately 9,000 lower-limb amputations per year in England. While pharmacists do not perform foot assessments, they can ask about foot care and ensure patients are attending their annual diabetic foot review. Selling appropriate footwear, emollients for dry cracked skin (avoiding between the toes), and referring patients who report new foot ulcers, colour changes, or loss of sensation are all within the pharmacy team's scope.
When to refer
Pharmacy teams should refer patients to their GP, diabetes specialist nurse or diabetologist when they encounter:
- Persistent hyperglycaemia (HbA1c consistently above target despite adherence)
- Recurrent hypoglycaemia
- Symptoms suggesting diabetic ketoacidosis (nausea, vomiting, abdominal pain, fruity breath — rare in type 2 but possible with SGLT2 inhibitors)
- New foot problems (ulcers, colour changes, loss of sensation)
- Suspected diabetic retinopathy symptoms (sudden vision changes)
- Pregnancy planning (pre-conception glycaemic optimisation is critical)
Pharmacists looking for clinical or diabetes-specialist roles can search current vacancies through PharmSee's job listings, which track over 1,700 active pharmacy roles across England.
Sources
- NICE NG28: Type 2 diabetes in adults — management (updated 2024).
- Diabetes UK. Facts and stats, 2024.
- NICE Technology Appraisals: dapagliflozin (TA679), empagliflozin (TA336).
- NHS England. Community Pharmacy Contractual Framework 2024/25.
- PharmSee pharmacy data: pharmsee.co.uk.