How often should people with type 2 diabetes see their GP?

From diabetes.co.uk/news

• A data-driven model suggested people at higher risk may benefit from shorter follow-up intervals when HbA1c rises, while stable lower-risk patients could safely have longer gaps.
• A separate study found the first appointments following a diabetes-range HbA1c were particularly important opportunities to document a diagnosis.
• Both studies used US healthcare data and neither proves that algorithm-based scheduling would improve NHS outcomes.

Seeing a GP more frequently is not automatically better for everyone with type 2 diabetes, according to research investigating how primary-care appointments could be scheduled according to individual risk.

Two studies from researchers at the University of Massachusetts Amherst examined different parts of the type 2 diabetes pathway: how frequently people already diagnosed with diabetes should be reviewed, and how quickly an abnormal HbA1c result leads to a documented diagnosis.

The findings suggest that the organisation of primary care may matter alongside individual patient characteristics.

But they do not support simply replacing existing appointment schedules with an algorithm.

Should higher-risk patients be seen more frequently?

The first study used electronic health records from 10 primary-care practices to develop a mathematical model for choosing follow-up intervals.

Rather than automatically reviewing everyone after one, three or six months, the model adjusted the recommended interval according to the person’s current health and diabetes trajectory.

People in the higher-risk group tended to be older and have more existing conditions such as chronic kidney disease and cardiovascular disease.

When HbA1c increased, the model favoured more frequent follow-up in these patients.

For lower-risk people whose glucose remained stable, it allowed longer intervals between appointments.

The model performed better on its mathematical optimisation measure than fixed appointment schedules, including a benchmark based on American Diabetes Association recommendations.

The basic idea is straightforward.

Seeing someone again too soon may provide little new information because HbA1c reflects blood glucose over approximately the previous two to three months.

Waiting too long, however, could allow worsening glucose control to go undetected.

A personalised schedule tries to find the point between those two extremes.

This was a modelling study – not a trial of patient outcomes

That distinction is important.

Researchers did not randomly assign thousands of people to algorithm-selected appointment intervals and then show fewer diabetes complications.

Instead, they used existing electronic health records to build and evaluate a Markov decision model.

Its better performance refers to the model’s predefined optimisation criteria.

It does not yet prove that the approach reduces hospital admissions, kidney disease, cardiovascular complications or mortality in real clinical practice.

A prospective trial would be needed before drawing those conclusions.

A second study examined delays in diagnosis

A separate study investigated 594 adults attending two US primary-care clinics between 2017 and 2023.

All had recorded an HbA1c in the diabetes range – at least 6.5%, equivalent to 48 mmol/mol – before receiving a documented diagnosis of type 2 diabetes.

The median time from the first diabetes-range HbA1c to diagnosis differed between the two clinics, at approximately 1.6 months and two months.

The investigators found that the first few appointments following the abnormal HbA1c appeared to be particularly important opportunities for diagnosis.

However, this finding needs nuance.

After adjustment for other factors, the study did not find statistically significant associations between primary-care location, continuity of care or visit regularity and time to diagnosis.

It would therefore be too strong to conclude that staffing levels or the clinic someone attends have been proven to cause diagnostic delays.

The study was exploratory and involved only two practices.

The researchers argue that differences in staffing, appointment availability and local practice processes deserve further investigation.

Why might diagnosis be delayed?

An HbA1c result does not operate in isolation.

Clinicians may need to repeat tests, review symptoms, rule out factors that can distort HbA1c and consider whether another form of diabetes is possible.

Diabetes.co.uk has guides explaining how diabetes is diagnosed and how the HbA1c test is used in type 2 diabetes.

The healthcare system also has practical constraints.

Appointments may be missed or delayed, laboratory results need reviewing and primary-care teams differ in workload and staffing.

That makes the period immediately following an abnormal result an obvious place to examine whether patients are being lost between testing and treatment.

What could this mean for the NHS?

The studies were conducted using US healthcare data, so the results cannot simply be transferred to NHS general practice.

The UK has different diagnostic pathways, staffing structures, diabetes reviews and commissioning arrangements.

But the underlying question is relevant.

People with type 2 diabetes are highly heterogeneous.

Someone with stable glucose, few complications and a consistent treatment regimen may not need exactly the same follow-up frequency as someone whose HbA1c is rising rapidly alongside kidney or cardiovascular disease.

More appointments are not automatically better if they add workload without changing care.

Equally, leaving a higher-risk person too long between reviews may delay medication changes or recognition of complications.

The potential value of the research is therefore risk-based follow-up, rather than simply increasing or reducing appointment numbers for everyone.

Before an algorithm like this could be used in the NHS, it would need prospective UK validation and evidence that it improves clinically meaningful outcomes without widening inequalities or making access harder for people who need support.

The studies make a sensible case for personalising follow-up.

They do not yet prove the best schedule for doing it.

https://www.diabetes.co.uk/news/2026/oct/how-often-should-people-with-type-2-diabetes-see-their-gp.html 

"Dear Doctor: Should I take weight loss drug with Type 1 diabetes and retinopathy?"

From oregonlive.com

Dear Dr. Roach: I’m a 73-year-old female who has Type 1 diabetes that began as Type 2 diabetes more than 30 years ago. I have a very strong family history of coronary artery disease, and I personally have a cardiac stent. I use an insulin pump and have good control with carb counting. I struggle with my weight (160 pounds at 5 feet, 2 inches tall) and with controlling my insulin dose. My A1C is 5.8%. I have ocular hypertension and some diabetic retinopathy. I receive Avastin injections in my eye approximately every two years.

My physician has ordered Mounjaro for weight loss. My concerns are my diabetic retinopathy and the diagnosis of Type 1 versus Type 2 diabetes. What are your thoughts on the safety of starting Mounjaro? -- C.D.C.

Answer: Type 1 diabetes is very different from Type 2. Type 1 diabetes is often diagnosed in childhood or adolescence and is an autoimmune disease that attacks the cells in the pancreas (islet cells), which make insulin. People with Type 1 diabetes have very little to no insulin.

People with Type 2 diabetes make normal or even high amounts of insulin. With Type 2 diabetes, the primary problem is resistance to insulin. Insulin can be used, but newer therapies are designed to reduce insulin needs.

Many people with latent autoimmune diabetes in adults (LADA) are initially misdiagnosed with Type 2 diabetes, and I suspect that this is your actual diagnosis. A diagnosis of LADA is typically made after age 30. (It sounds like you had problems beginning around age 40.) There’s no insulin requirement for at least six months, and blood tests confirm the presence of islet-cell antibodies. People with LADA usually have Type 1 diabetes.

You have disease in both the small blood vessels (Avastin is used for diabetic retinopathy, a small vessel disease) and large vessels (the stent in your coronary artery), which can happen with either type of diabetes but is consistent with Type 1. There’s strong evidence that GLP-1 drugs are helpful in preventing heart attacks in people with Type 2 diabetes but not for those with Type 1 (although they still may be helpful).

Your question is about the use of tirzepatide (Mounjaro when used for diabetes) for Type 1 diabetes. Your A1C is in the nondiabetic range; I don’t recommend new medication to lower your A1C further, so it seems like you’d be using it for weight. The expert opinion does recommend medicines like tirzepatide for weight loss in people with Type 1 diabetes who are obese, but your BMI of 29.3 doesn’t meet the definition of obese.

So, there is a safety issue in that even modest doses of Mounjaro could cause a drop in your blood sugar. Having an insulin pump (especially when combined with a continuous glucose monitor) can reduce this risk. But if you do go on Mounjaro, you should pay careful attention and regulate your carbohydrate intake to avoid ketosis (ketones in the urine, which show inadequate cellular nutrition and put you at risk for diabetic ketoacidosis). The normal dose escalations used for obesity or for Type 2 diabetes may be too aggressive, so your doctor should increase the dose very slowly.

You may also be at a higher risk for the nausea and vomiting that is common among people taking GLP-1 agents, although most people with Type 1 diabetes did develop a tolerance to the drug. In summary, Mounjaro may be effective at helping you lose weight, although your blood sugar and ketone levels should be monitored by an expert.

https://www.oregonlive.com/advice/2026/07/dear-doctor-should-i-take-weight-loss-drug-with-type-1-diabetes-and-retinopathy.html 

Preventing Amputation: a Doctor’s Guide for Diabetes Patients

From blackpressusa.com

Amputation is often a last resort for diabetes patients facing severe infections or poor circulation. However, Dr. Estelle Everett, an endocrinologist at UCLA, states that most diabetes-related amputations are preventable through early intervention, consistent medical care, and patient education 

For many diabetes patients, amputation becomes a last-resort measure after infections, ulcers, or poor circulation worsen rapidly and leave few other treatment options.

But according to Dr. Estelle Everett, a physician and researcher specializing in endocrinology, diabetes, and metabolism at the University of California, Los Angeles (UCLA), most diabetes-related amputations can be prevented through early intervention, consistent medical care, and patient education.

For Everett, her commitment to diabetes prevention is deeply personal. Watching her younger sister navigate Type 1 diabetes exposed her early to the challenges many patients face, including barriers to advanced diabetes technologies such as continuous glucose monitors and insulin pumps due to racial disparities in patient care.

Those experiences helped shape her focus on prevention, education, and equitable access to care.

Dr. Everett spoke with California Black Media (CBM) about the warning signs of diabetic complications, prevention strategies, healthcare access, and the role of diabetes technology in improving outcomes.

                                                                                                Photo courtesy UCLA Health

What are some of the early warning signs that a person with diabetes may be developing circulation and nerve problems that could potentially lead to amputation?

Amputation is usually the final stage of diabetic foot disease. Earlier signs often involve nerve damage. Some people experience numbness, tingling, burning, or loss of sensation in their feet.

Poor circulation is another warning sign. Symptoms can include calf pain with walking, foot pain at rest, cold feet, changes in skin color, or wounds that do not heal properly. Foot ulcers, thick calluses, and untreated cuts can also lead to serious infections that may eventually require amputation if not treated early.

Before complications reach that stage, what are some early signs of diabetes that people should look out for?

Many people are walking around with diabetes and do not even realize it. Some patients first seek medical care only after they’ve already developed complications because they’ve had diabetes for years without knowing it.

That’s why routine screenings are so important. If you have diabetes, controlling it early can significantly reduce the risk of severe complications later on.

Many Black Californians harbor a degree of distrust in the healthcare system. What message would you send to encourage people to get regular checkups?

Distrust is real, and there are many reasons people may avoid healthcare. Some fear discrimination or worry they’ll simply be judged instead of helped.

Personally, I realized some of the care my sister received may have been influenced by racial bias. Although she had diabetes for years, she was never offered diabetes technology like insulin pumps or continuous glucose monitors. When she finally asked about them, she was told she had to jump through many hoops.

Later, I realized her experience wasn’t unique. Research shows that minority patients and people from lower-income backgrounds are less likely to be offered diabetes technology. That inspired me to focus my research on improving access for the populations that need these tools the most.

I think building trust is important. Finding the right doctor is almost like dating. If you don’t feel comfortable with your provider, it may help to find someone you connect with and feel understands your concerns. That relationship can make a major difference in getting consistent care.

Are there newer technologies or innovations in diabetes care that people should know about?

One of the biggest advances has been continuous glucose monitors, or CGMs. These small wearable devices track blood sugar levels in real time and have really changed diabetes care over the past decade.

For providers, CGMs give a much clearer picture of blood sugar patterns throughout the day. For patients, they provide immediate feedback about how food, exercise, and other daily habits affect blood sugar levels.

Someone may notice that certain foods cause major spikes while certain exercises lower their blood sugar. That real-time information helps people make healthier decisions and improve blood sugar control. Research shows these technologies can significantly improve outcomes.

What daily habits or preventative measures can reduce the risk of complications or even amputation?

The biggest thing is controlling your diabetes. A lot of people automatically think diabetes will lead to amputations, but research shows the risk is much lower when diabetes is well managed.

That means taking medications as prescribed, making dietary changes, and working to keep your A1C below 7. Managing high blood pressure and high cholesterol is also important because both contribute to circulation problems.

People should also inspect their feet every day, especially if they’ve already lost sensation. Some patients injure their feet without realizing it because they can’t feel the damage. Catching wounds early is critical. Good foot hygiene also plays a major role in prevention.

Are there any common misconceptions about diabetes that stand out to you in your clinical work with Black patients?

One major misconception is that diabetes medications cause complications like kidney failure or amputations. In reality, poorly controlled diabetes causes those complications — not the medications used to treat it.

Those misconceptions sometimes cause patients to avoid medications or stop taking them altogether. Another issue is that some people believe diet and exercise alone should always control diabetes. While lifestyle changes are important, some patients have severe diabetes that also requires medication.

Needing medication is not a personal failure. Sometimes diet and exercise alone are simply not enough, and medication is necessary to prevent serious complications.

This article is supported by the California Health Care Foundation(CHCF). Visit www.chcf.org

Based on reporting by San Diego Voice & Viewpoint.

https://blackpressusa.com/preventing-amputation-a-doctors-guide-for-diabetes-patients/

7 Ways a Pharmacist Can Help You Manage Type 2 Diabetes

From everydayhealth.com

If you have type 2 diabetes, you may already be seeing an endocrinologist, a primary care doctor, and even a dietitian. But there may be one healthcare provider you’re overlooking: a pharmacist.

“Diabetes is a complicated condition, and pharmacists are here to support you,” says Alexa Valentino, PharmD, an associate professor of clinical pharmacy at The Ohio State University College of Pharmacy in Columbus. And they can do far more than simply hand over medications. 

In fact, research shows working closely with a pharmacist can help you stick to diabetes treatment and improve overall outcomes. This was echoed in a study among Spanish-speaking adults with diabetes, in part because pharmacists were able to expand people’s access to medication assistance programs that covered additional treatments. The pharmacists also encouraged people to stay up to date on recommended health screenings.

                                                                                                                                                                                            iStock

Whether you work with a community pharmacist or one who is part of a collaborative diabetes management team, there are benefits to knowing how they can support type 2 diabetes care. They can:

1. Provide Education on Diabetes Medications and Supplies

If you’ve ever left a diabetes checkup feeling unsure about the next steps regarding treatment, you’re not alone. A pharmacist can help fill in the blanks. 

“Your pharmacist can answer any drug-related questions you have,” says Phil Rodgers, PharmD, a professor of diabetes care and patient communication and vice chair of education in practice advancement and clinical education at the University of North Carolina Eshelman School of Pharmacy in Chapel Hill. That can include things such as:

• How diabetes medications differ and how each one works
• When and how to take certain medications
• How to properly store medication
• Which side effects can occur
• What to do if you miss a dose

“Your pharmacist can also help you select diabetes supplies, [including] glucose monitors,” says Rodgers. 

2. Spot Drug Interactions and Safety Concerns

Pharmacists are trained to catch small issues before they become larger ones. “Your pharmacist can review all of the medications and supplements you take to make sure there are no drug interactions or concerns about how they might affect your blood sugar,” says Valentino. 

Be sure to tell your pharmacist about any factors that may affect the treatment regimen, including if you:

• Experience any new symptoms or side effects, such as diarrhoea or nausea 
• Have trouble taking medications exactly as directed
• Go through any changes in your diet or overall health
• Are pregnant or breastfeeding

If you get sick or need to take other over-the counter medications, a pharmacist can also help you choose an option that won’t interfere with diabetes treatment, says Rodgers.

3. Offer Resources to Lower the Cost of Treatment

Diabetes medication can be expensive, but going without treatment can worsen your overall health and potentially lead to even costlier medical bills in the future.

A pharmacist can recommend resources that can help lower your out-of-pocket costs, says Valentino. This may include:

• Switching to generic medications
• Looking into cost-savings programs through pharmaceutical websites
• Recommending patient assistance programs through drug manufacturers 

“Pharmacists can help you understand the insurance process, too, because it can be complicated to navigate prior authorizations and figure out what’s covered,” she says. “Pharmacists do their best to help you find the most cost-effective options.”

4. Support Blood Sugar Monitoring 

Pharmacists can also help you with blood sugar monitoring, especially as you’re learning how to track and interpret results. They can:

• Discuss target blood sugar ranges
• Review how often you should test your blood sugar levels
• Teach you how to use a blood glucose meter or continuous glucose monitor
• Make sure you’re using the device correctly
• Teach you how to log or store your results and share them with your care team
• Teach you how to store test strips and other supplies
• Troubleshoot common issues, such as inaccurate readings or malfunctioning meters

Pharmacists can also help you spot trends in your blood sugar levels that may be worth mentioning to the rest of your type 2 diabetes care team.

5. Recommend Diabetes-Friendly Lifestyle Changes

“Pharmacists do a lot of education and discussion around lifestyle,” says Valentino. They can explain how exercise, food, illness, medications, and stress all have an impact on blood sugar patterns and offer practical guidance on what you can do to bring levels down again. For example:

• How to time medications to avoid postmeal blood sugar dips
• Why taking a walk after dinner can help bring blood sugar down faster
• When to add in a late-night healthy snack to make sure your blood sugar isn’t dropping too low overnight

When you meet with a pharmacist regularly, they’re often in a good position to notice patterns and encourage small, sustainable changes for better blood sugar control.

6. Suggest Preventive Care to Reduce the Risk of Complications 

It’s important to get routine preventive care when you have diabetes, and pharmacists can help you stay up to date on vaccinations, dental appointments, eye exams, and more. “There are a lot of health maintenance types of things that need to happen when you have type 2 diabetes,” says Valentino. More specifically, you may need to schedule:

• Cholesterol tests
• Dental exams
• Eye exams
• Foot exams
• Hearing tests
• Kidney tests
• Mental health support
• Routine vaccinations

By encouraging you to schedule these appointments, a pharmacist can help you be more proactive about diabetes care.

7. Relay Messages to the Rest of Your Diabetes Care Team

Pharmacists can play a key communication role with the rest of your diabetes care team. Because you’ll likely see your pharmacist more often than other healthcare providers, “Pharmacists can share insights they’re seeing … or any issues they might notice with the rest of your [healthcare providers],” says Rodgers. 

At the same time, your other healthcare providers may contact your pharmacist with questions or instructions. This back-and-forth communication allows for a more team-based approach to your care, with each healthcare provider contributing to a more complete picture of your health.

How to Communicate With Local and Mail-Order Pharmacies

Community pharmacists, such as those at a local grocery store or retail pharmacy chain, are very accessible in day-to-day life. “You can go up to the window or pharmacy counter on the spot to get the help you need,” says Rodgers. 

“There may be times when the pharmacy is busier than others,” he says, “but you can often call to ask when the best time is to drop by to address your needs.”

But even if you primarily use a mail-order or home delivery pharmacy, you still have access to support from a pharmacist. “You can ask to speak with the pharmacist over the phone,” says Valentino. 

She adds that many people who use mail-order pharmacies also have a local community pharmacy for urgent prescriptions or gap refills. That way you can still speak directly with a pharmacist about any questions or concerns you may have.

The Takeaway

• A pharmacist is a valuable member of your type 2 diabetes care team. They can teach you how to use medication correctly and make lifestyle changes to better manage your blood sugar levels, as well as recommend routine preventive screenings.
• They can also help reduce barriers to care by addressing cost, improving access to treatments, and reinforcing the importance of vaccinations and routine health maintenance. 
• Even if you use a mail-order pharmacy, there are still pharmacists available to speak with you over the phone.

https://www.everydayhealth.com/diabetes/how-pharmacists-can-help-manage-type-2-diabetes/ 

6 Supplements That Can Interfere with Blood Sugar Medications

From verywellhealth.com

Many people with diabetes or prediabetes try supplements to help control their blood sugar. However, some supplements can change how prescription diabetes drugs work—either by lowering blood sugar too much, or by affecting how much your body absorbs the drug.

                                            Certain supplements can affect how diabetes medications work.    agrobacter / Getty Images

1. Berberine

Berberine can add to metformin’s effects, meaning stronger glucose-lowering and gastrointestinal (GI) effects

Berberine (from plants such as Berberis) has blood sugar (glucose)-lowering effects and is sometimes used as a “natural” alternative to metformin. Studies and reviews have shown similar mechanisms between berberine and metformin. For example, both can help reduce the amount of glucose produced by your liver. This can lead to additive or synergistic effects when taken together, so your blood sugar may drop too low. The similar effects also mean that GI side effects can be worsened.

Talk to your healthcare provider before planning to take berberine. If you are also taking metformin or another glucose-lowering medication, you may need to closely monitor your blood sugar levels and review your dosing with your provider.

2. Cinnamon

Cinnamon can increase the risk of low blood sugar when combined with medications.

Cinnamon and cinnamon extracts have been reported in multiple trials and reviews to modestly lower fasting glucose and haemoglobin A1c (average blood sugar level over two or three months) in some people.

This effect means that cinnamon supplements can enhance the glucose-lowering effect of prescription medications, such as sulfonylureas or insulin, especially when taken in concentrated form rather than as a sprinkle of the spice. 

Clinical evidence is mixed, but caution is warranted. "Natural” doesn’t mean harmless, and you should check your blood glucose more often if you start taking a cinnamon supplement.

3. Ginseng

Unpredictable effects mean ginseng may increase or decrease the effect of prescription diabetes medications.

Different ginseng preparations (e.g., American, Asian) and study designs produce inconsistent results, but studies show that ginseng can affect insulin secretion, glucose uptake, and postprandial (after a meal) glucose.

In individuals already taking oral blood sugar-lowering drugs or insulin, ginseng may have the potential to cause additive glucose-lowering effects, which can lead to hypoglycaemia (too low blood sugar), or alter their responses to these medications.

Commercial ginseng products can vary widely in potency and formulation. Be sure to consult with your healthcare provider before starting this supplement.

4. St. John's Wort

St. John's wort may change drug metabolism, affecting how much of your diabetes medications get absorbed.

St. John’s wort increases the activity of CYP3A4 (a drug-metabolizing enzyme in the body) and certain drug transporters (proteins responsible for drug absorption, distribution, and elimination). As a result, it can reduce the blood levels of medications that share these pathways. For this reason, it is notorious for interacting with many different medications. 

While many diabetes drugs do not get broken down by the CYP3A4 enzyme, St. John’s wort has been shown to alter the way metformin works in your body in at least one trial. It can also interact with many other medications.

Stage TB, Pedersen RS, et al. Intake of St John's wort improves the glucose tolerance in healthy subjects who ingest metformin compared with metformin alone. Br J Clin Pharmacol. 2015;79(2):298-306. doi:10.1111/bcp.12510

Because of its unpredictability with interactions, it's recommended to avoid combining St. John’s wort with complex medication regimens without supervision from your healthcare provider.

5. Aloe Vera

Aloe vera can lower glucose and interact with diabetes medications.

Aloe vera has been studied for its effects on processes that contribute to high blood sugar levels. Studies suggest that it may be beneficial in reducing fasting glucose and haemoglobin A1c levels, particularly in stabilising blood sugar levels after meals.

However, the extent to which aloe vera affects blood sugar levels is unknown. Tell your healthcare provider if you are taking an aloe vera supplement. Keep in mind that aloe vera formulations also vary, and some can cause side effects, such as GI upset.

6. Chromium

Chromium supplementation has shown modest improvements in insulin sensitivity and haemoglobin A1c in some studies. Other studies have shown benefit only in people with poor nutritional status or already low chromium levels. 

Because chromium can enhance insulin action, using it with a prescription blood sugar-lowering drug can raise the risk of hypoglycaemia, especially if the doses are higher than those found in multivitamins.

According to the Food and Drug Administration (FDA) and the Institute of Medicine, it is safe when taken at a dose of 200 micrograms daily for up to six months.

Keep in mind, chromium supplements may also carry side effect risks like GI upset or headaches. Caution should be used if you have kidney or liver issues. Talk to your healthcare provider about whether chromium supplements may be beneficial for you.

Always inform your healthcare provider and/or pharmacist about any supplements and include them on your list of medications—even “natural” ones—so medication dosing and monitoring plans can be adjusted as needed.

https://www.verywellhealth.com/supplements-to-avoid-with-blood-sugar-medication-11864779