NICE sets out a shake-up in Type 2 diabetes care
Millions of people are set to benefit from earlier access to newer Type 2 diabetes treatments as part of NICE’s commitment to the 10-Year Health Plan for the NHS. The draft guidelines from NICE moves away from a ‘one-size-fits-all’ approach, shifting from automatically starting everyone on one medicine to personalised treatment plans that aim to prevent heart failure, heart attacks and other serious medical problems.
NICE’s guidelines have expanded access to the newer diabetes medicines called SGLT-2 inhibitors (names like canagliflozin, dapagliflozin, empagliflozin and ertugliflozin) from being second-choice treatments to first-choice treatments. The same groups of patients also stand to benefit from the much talked about type of medicine called GLP-1 receptor agonists (such as liraglutide or semaglutide), instead of keeping them for later stages of treatment.
New evidence
- For patients who cannot tolerate metformin, previously the traditional first line diabetes medicine, the new guidelines recommend starting with an SGLT-2 inhibitor on its own. This is because growing evidence shows they protect the heart and kidneys, as well as controlling blood sugar.
- New evidence also suggests that nearly 22,000 lives could be saved once uptake of the recommended changes for SGLT-2 inhibitors as a joint first line treatment option with metformin, reaches 90% of the patient population.
People with Type 2 diabetes should speak with their GP or diabetes team at their next annual review meeting to discuss what treatment option is right for them.
The guidelines also address concerns about under-prescribing of SGLT-2 inhibitors, with evidence showing these medicines are not being offered equitably across the UK. NICE analysed records of almost 590,000 people and found that SGLT-2 inhibitors are under-prescribed, particularly to women, older people and Black or Black British people.
Press Release: National Institute for Health and Care Excellence (NICE) 20 August 2025
