Managing Type 2 Diabetes in Primary Care: Updated Guidelines

The updated South African guidelines for managing Type 2 diabetes in primary care settings were published in March 2026. This clinical review covers key changes in first-line therapy, glucose monitoring targets, and referral criteria.

By Dr. Sarah Nkosi 12 Jun 2026 8 min read 1 CPD

Introduction

The 2026 South African guidelines for Type 2 diabetes management represent a significant shift from previous recommendations. This article summarises the key changes relevant to primary care practitioners.

First-Line Therapy

Metformin remains the cornerstone of first-line pharmacotherapy. However, the new guidelines introduce earlier use of SGLT2 inhibitors in patients with established cardiovascular disease or chronic kidney disease, regardless of HbA1c levels.

Glycaemic Targets

The HbA1c target of ≤7% remains recommended for most patients. For elderly patients or those with significant comorbidities, a less stringent target of 7.5-8% may be appropriate.

Referral Criteria

Referral to a specialist physician or endocrinologist is recommended when: HbA1c remains >9% despite triple therapy, eGFR declines below 30 mL/min, or recurrent hypoglycaemic episodes occur.