💔 Breakups, ⚖️ Bailiffs and ⚠️ Big Guideline Updates

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Hand-picked headlines. Esoteric punchlines. And, of course, Colonel Statins’ secret recipe from 1962. You just can’t rush flavour like this.

👋 Happy Friday. Here’s what we got:

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Hey you! 

Have you finally done the work and committed those pesky T2DM guidelines to memory?

Well, toss it out the window, because the guidelines have updated, and your hard-earned knowledge has become obsolete once again. Happy Friday! 

Here are 4 major changes to know about 🧏

Flozins Now First Line

SGLT2s are Tier 2 no longer. 

Once a humble second, even third-line glycaemic control drug, their rise through the T2DM flowchart to now claim a spot next to metformin is impressive indeed.

But why the promotion?

Because they don’t just lower glucose. They protect the heart AND the kidneys too.

And after analysing the records of nearly 600,000 patients, NICE concluded they have been underprescribed across the board, especially amongst women, Black people and elderly patients. Little surprise there.

The new guidelines suggest starting with metformin and checking tolerability before adding in an SGLT2 - the new first-line dream team.

And the flozin’ hype doesn’t stop there. Thanks to the end of its original brand patent in mid 2025, dapagliflozin is now available as a cheaper, generic version, saving the NHS upwards of £560 million🤑

But remember, as great as they are, flozins do have their drawbacks …

Metformin’s Midlife Crisis

Now forced to share the limelight with SGLT2s, metformin is having a moment of its own.

Famed for its troublesome effects on the GI tract, NICE has decided to do away with standard metformin altogether, and instead opt for ✨modified-release metformin✨ straight away.

The Weight Is Over: NHS Embraces GLP1s

And it’s not just the -flozins enjoying the glory. 

GLP-1 receptor agonists are also being welcomed into the algorithm earlier, particularly for those with CVD disease, obesity or T2DM before age 40.

In case you needed a reminder, GLPs lower blood glucose AND cause significant weight loss (take a look at most celebs these days), PLUS reduce risks of heart attacks and strokes. 

Not just that:

A Bigger Focus on Tailored Treatment

Diabetes care needs to be altered to suit the individual, and the new guidelines reinforce this.

All the old players still have their role, even pioglitazone (not just a textbook urban myth apparently)

The new guidelines hammer home the importance of working with the patient to choose what best suits them from the range of treatments available. 

So that’s the latest tea from NICE T2DM. 

Same time next year for T2DM 3.0?
Let’s just hope the passmed textbook can keep up.

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Huh.
Would you look at that… that Ozempic stuff really does work. 

You’re trim.
You’re slim. 
You can barely recognise yourself.

And all it cost was a fib to your telehealth doc, a bit of nausea, a bit of vomiting, and - oh yes - that charming little gallstone removal.

Totally worth it. 

Your GP looks you up and down while you do a little celebratory twirl in the consultation room.

“Now that you’re at an …acceptable weight, it’s time to think about coming off the GLP”

A bit blunt, but alright. 

The jab has served its purpose.
You’ve had your fun.
It’s time to go your separate ways.

You agree to stop the shots and quit semaglutide for good. 

They run through the standard warnings, uncontrolled hyperglycaemia, risk of DKA, pancreatitis. Y’know, the usual clinical housekeeping.

As they glaze over the T&C’s, one side-effect catches your attention.

“You may regain the weight you lost.”

Regain the weight ???
As in… some of it?
Or as in all of it?

“Yes,” they say, as they load the BMJ onto their Windows XP computer. “All of it.”

This meta-analysis, published in the British Medical Journal, wanted to dive deep into what happens to people after stopping Weight Management Medications(WMM).

They wanted to quantify:

To be included in the analysis, studies had to have patients on WMMs (including semaglutide, tirzeparide, liraglutide, exenatide + legacy drugs like orlistat and toparimate) for a period of 8 weeks, followed by at least 24 weeks of follow-up after stopping the drug. 

They perused through thousands of records and whittled them down to just 37 studies, involving 9,341 participants in total. 

After completing their statistical wizardry, this is what they found:

What's worse is how it stacks against the neanderthal who prefers diet and exercise:

So no, GLP-1s aren’t a cure. They’re effective. But they work the way most chronic medications work: while you’re taking them.

Stop the injections, and your body remembers its love for Jaffa Cakes and Maltesers.

The study suggests that both behavioural management + weight loss management are the best options for keeping that weight off(who would have thought).

Weight, much like a toxic ex, always comes back.
And if you really want that breakup to stick, you probably need some therapy 🤷

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Work From Abroad: Doctor Edition

Are you ready to ditch the terrible, turbid weather that plagues the UK? Looking for a fresh start without giving up your job?

Well, ladies and gents, an opportunity is emerging: Overseas GPing

A company called Asterix Health is piloting overseas-based doctors providing remote support to GP practices in England.

The whole thing is focused on telephone and video consultations. Fully registered GMC doctors would set up their laptops from wherever in the world and run tele-clinics as if they were a normal GP.

The concept is currently being trialled with 8 doctors, working from places like Australia, Malaysia and India at 7 different UK practices.

All cool as it all sounds, the GP model becoming a glorified call centre seems a little dystopian to me. Something fresh nonetheless. 

Doctors Say No To Palantir

Doctors and patient groups are outraged by the national rollout of the AI-Assisted Discharge Summary system (yes, they couldn’t think of a more slick name than that .. AIDS perhaps?)

On the surface, the tool developed by Chelsea and Westminster Hospital seems like a slick, time-saving widget. What’s the fuss?

Well, it’s being operated by Palantir, cofounded by the winner of the world’s sweatiest billionaire, Peter Thiel.

And fears about AI hallucination, lack of regulatory approval, and having a cofounder whose name has appeared in reporting on the recently released Epstein files, are a slight cause for concern.

All the same, it’s full steam ahead for the AIDS system. 

We Paid You Too Much, Now It’s Your Problem

It was all well and good getting an applause once a week during COVID, but y’know what really shows us you appreciate NHS staff is cold hard cash 🤑

Unfortunately, NHS England does not believe in performance-based compensation. If you do happen to see more than you expect on payday, don’t get excited. 

Freedom of information shows that over 50,000 staff members were overpaid last year. And if you don’t repay your “debt”, the bailiffs are coming your way. 2,683 staff members had bailiffs called on them in 2024-25.

Payroll glitch? Your problem. Nothing says “we value our staff” like a county court letter.

Is Intermittent Fasting a Farce?

Keto. Intermittent Fasting. Juice Cleanses. All diet regimens suggested by guests of the Diary of a CEO podcast. 

After listening to a 2-hour lecture on their benefits, from a “clinician” wanting to promote their new cookbook, you wouldn’t be blamed for buying into their manifesto.

But what does the evidence say? Well, a Cochrane review challenges the hype of intermittent fasting. 

They found most of the evidence weak. And of the 22 RCTs that they did approve, there was no difference in weight loss, QoL or adverse events compared to regular diet advice.

Guess we’ll be sticking to the NHS Healthy Plate in lifestyle advice after all.

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