Ranked one of the best clinical decision support tools for health professionals worldwide, BMJ Best Practice provides step-by-step guidance on diagnosis, treatment and prevention.
Updated daily using robust evidence-based methodology and expert opinion, BMJ Best Practice provides you with access to the very latest clinical information.
NICE recommends earlier SGLT2 inhibitor use and comorbidity-led treatment pathways
NICE has updated its guidance on the management of type 2 diabetes in adults, introducing a shift towards earlier combination therapy and more explicit comorbidity-led treatment pathways.
For most adults without relevant comorbidity, first-line treatment is now modified-release metformin plus a sodium-glucose cotransporter-2 (SGLT2) inhibitor, rather than stepwise monotherapy escalation. SGLT2 inhibitors may also be used as monotherapy where metformin is not suitable.
Initial treatment is now more clearly structured according to comorbidities, including cardiovascular disease, heart failure, chronic kidney disease, obesity, and frailty. The guidance also provides clearer recommendations on the continuation and discontinuation of glucagon-like peptide-1 (GLP-1) receptor agonists and tirzepatide, and emphasises the cardiovascular and renal benefits of SGLT2 inhibitors, which may be continued even if glycaemic targets are not achieved.
There is increased emphasis on shared decision-making, optimisation of existing therapy before escalation, and reinforcement of sick day rules, particularly for SGLT2 inhibitors.
CDC recommends extended 5-day treatment course of artemether/lumefantrine
The Centers for Disease Control and Prevention (CDC) have extended the treatment course for artemether/lumefantrine, the only oral artemisinin-based combination therapy (ACT) available in the US, in its recently updated malaria guidelines.
Previously, the CDC recommended a 3-day course (6 doses) for the treatment of uncomplicated Plasmodium falciparum infection (or infection caused by an unknown species). However, due to reports of treatment failure with artemether/lumefantrine the increasing spread of artemisinin partial resistance and decreasing susceptibility of P falciparum to lumefantrine, the agency now recommends an extended 5-day course (10 doses) for the treatment of uncomplicated P falciparum infection, or as follow-on oral treatment for severe malaria after administration of intravenous artesunate.
Under the new 5-day regimen, the patient takes an initial dose and a second dose 8 hours after on day 1, followed by twice daily dosing on days 2-5.
For uncomplicated infections due to other species (P vivax, P ovale, P malariae, P knowlesi), a 3-day course is still recommended, when indicated.
The CDC also now explicitly advises that patients with P falciparum or P knowlesi infection (or infection with an unknown species) be hospitalised for initial treatment with daily blood smears to ensure the treatment is effective.
It is important to note that the current World Health Organization (WHO) guidelines, last updated in August 2025, still recommend a 3-day course of ACT (including artemether/lumefantrine) for the treatment uncomplicated P falciparum infection.
There were an estimated 282 million malaria cases worldwide in 2024 in 80 endemic countries, resulting in an estimated 610,000 deaths. Approximately 94% of all malaria cases and 95% of deaths occurred in the African region, and the majority of deaths were due to P falciparum infection.
Global consensus to rename polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) has been renamed ‘polyendocrine metabolic ovarian syndrome (PMOS)’. The new terminology moves away from the previous emphasis on ovarian cysts and reflects the endocrine, metabolic, and reproductive manifestations of the condition, such as menstrual irregularities, infertility, metabolic dysfunction, diabetes, cardiovascular disease, and mental health comorbidities.
Uganda confirms Marburg case as Ebola outbreak continues
A case of Marburg disease has been reported in Uganda amidst the ongoing Ebola outbreak that continues to affect the country. The case involved an 18-month-old female from the Kyegegwa District in the Western Region of the country, who died of suspected Ebola infection, but later tested positive for Marburg. No further cases have been reported at the time of publication.
This is the first case of Marburg disease in Uganda since the last outbreak occurred in October 2017. Sporadic cases have been reported in the country since 2007, with the largest outbreak in 2012 (15 cases and 4 deaths).
The highest ranking* CDS app
Access clinical information anywhere, even offline, with our award-winning app.
Whether you’re on the ward, at home, or studying, the BMJ Best Practice app gives you trusted decision support information in an instant. The app is provided for free to those who have a personal subscription to BMJ Best Practice or have access provided by their institution.
* As of 23 August 2023
It’s no understatement to say that this app (and the website) is responsible for getting me through medical school. Nowhere else can you get such succinct and relevant summaries and treatment algorithms.
BMJ Best Practice app user
Bacterial meningitis in adults: explore our topic
Meningitis is currently important in the UK and many other countries around the world. This topic will help you learn how to:
- Diagnose the condition confidently
- Manage patients effectively
- Share information with patients
- Advise about vaccination
Have you used our Comorbidities Manager?
Managing the treatment of patients with comorbidities is hard – clinical guidelines only focus on single conditions – but failure to manage comorbidities leads to worse clinical outcomes and longer lengths of stay.
Our unique Comorbidities Manager* provides guidance on the treatment of a patient’s acute condition alongside their preexisting comorbidities.
*This feature is only available if your institution has purchased the Comorbidities Manager. If you have access it will appear under the ‘Your Profile’ section in the menu at the top of the page.
Learn more
At a glance
One in three adults suffer from multiple chronic conditions and most patients in the acute setting have more than one medical condition.
- Treat patients with comorbidities with confidence
- Better understand the complexities of treating multiple conditions
- Achieve better outcomes for patients