Millions of people living with type 2 diabetes could gain earlier access to life‑extending treatments under new NICE recommendations. The guidance introduces major changes to how type 2 diabetes is treated in England, including offering SGLT‑2 inhibitors (‘flozins’) much earlier in the care pathway.
Alongside these clinical benefits, the NHS is expected to save £560 million over 2025/26 and 2026/27 thanks to the availability of generic dapagliflozin, a widely used SGLT‑2 inhibitor. These savings can be reinvested into diabetes education programmes, community support, and other parts of NHS care.
NICE analysis estimates that using SGLT‑2 inhibitors earlier, together with GLP‑1 receptor agonists and tirzepatide for specific groups, could prevent around 17,000 deaths over three years across the UK. These medicines not only lower blood sugar but also protect the heart, support kidney health, and reduce risks of heart attacks, strokes, and kidney disease
Heart disease remains the leading cause of death among people with type 2 diabetes, making these updated recommendations particularly significant.
Under previous guidance, most people began treatment with metformin alone. The new approach recommends:
- Metformin + an SGLT‑2 inhibitor from the start for most people
- A “slow‑release” version of metformin to reduce stomach upset
- Tailored prescriptions based on personal circumstances
The guidance emphasises an individualised approach – with treatment choices made jointly by patients and healthcare professionals.
SGLT‑2 inhibitors work by helping the kidneys remove excess glucose, but research shows they also provide substantial cardiorenal protection, which is why NICE now recommends earlier access.
NICE reviewed anonymised records from nearly 590,000 people and found that SGLT‑2 inhibitors are not prescribed equally across different groups. The data showed underprescribing among women, older adults, and black people. New recommendations ask NHS services to monitor prescribing patterns and take action to reduce inequalities.
The guidance sets out clear treatment pathways tailored to different patient groups:
- People diagnosed before age 40 may benefit from adding GLP‑1 receptor agonists or tirzepatide due to their higher lifetime risk of heart and kidney complications.
- People living with obesity receive specific recommendations that reflect their health needs.
- Patients with existing kidney disease or heart failure may benefit most from earlier access to SGLT‑2 inhibitors.
Up to 810,000 more people could become eligible for GLP‑1 receptor agonists and tirzepatide under the new guidance.
While newer medicines offer major benefits, they won’t be suitable for everyone. Healthcare professionals will:
- Check each person’s heart and kidney health
- Introduce new medicines one at a time
- Review treatment regularly to ensure continued benefit
A new prescribing guide will support clinicians in making safe and personalised decisions.
NICE’s Interim Director for the Centre for Guidelines, Eric Power, commented:
“This is a landmark moment for diabetes care. Our independent committee conducted a rigorous review of the evidence and concluded that by offering certain medicines earlier, we can prevent thousands of heart attacks, strokes and cases of kidney failure – keeping people healthier for longer while reducing pressure on NHS services.
"But we also found something troubling: these life-saving medicines are currently under-prescribed to women, older people and Black patients. Tackling health inequalities is at the heart of what NICE does, and these recommendations will help ensure everyone with type 2 diabetes gets fair access to the best available treatments.
"By recommending generic dapagliflozin where clinically appropriate, we're also freeing up hundreds of millions of pounds that can be reinvested elsewhere in NHS care. This is evidence-based guidance that saves lives and delivers value for the taxpayer."
The guidance emphasises that medicines are just one part of effective diabetes management. Discussions will continue around diet, physical activity. Weight management and programmes like the NHS Type 2 Diabetes Path to Remission Programme. For some people, lifestyle changes can even help place diabetes into remission.
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