Key Summary
- The newly-diagnosed type 2 diabetes patients will be offered SGLT-2 inhibitor, along with metformin.
- However, there in on one-size-fits-all approach, and healthcare professionals should work with each patient to find the right treatment for them.
- SGLT-2 inhibitors help kidneys remove excess sugar from the body, and protects heart.
The National Institute for Health and Care Excellence (NICE) has issued a new guidance allowing the use of SGLT-2 inhibitors, known as ‘flozins’, much earlier while treating diabetes patients, to protect the heart and kidneys.
The NICE analysis suggests that introducing SGLT-2 medicines earlier in the treatment pathway, and the introduction of GLP-1 receptor agonists and tirzepatide for some patients, will reduce the risk of heart attacks, strokes and kidney problems.
Till now, the newly diagnosed type 2 diabetes patients have been prescribed metformin. Now they will be offered metformin along with an SGLT-2 inhibitor from the start.
Different approaches
However, this isn't a one-size-fits-all approach and healthcare professionals should work with each patient to find the right treatment for them, based on their other health conditions, the medicines they already take, and what matters most to them.
Decisions should be made together, with regular check-ups to make sure treatments are still working.
People diagnosed with type 2 diabetes before 40 face a higher risk of heart and kidney problems, so may benefit from adding a GLP-1 receptor agonist (such as semaglutide, dulaglutide and liraglutide) or tirzepatide.
Semaglutide will now be recommended for people with type 2 diabetes who also have cardiovascular disease caused by blocked arteries (such as previous heart attacks or strokes).
GLP-1 receptor agonists and tirzepatide will be recommended for people who were diagnosed before age 40, or who are living with obesity.
People who already have kidney disease or heart failure have tailored recommendations, with SGLT-2 inhibitors offering particular benefits for protecting their kidneys and heart.
SGLT-2 inhibitors help the kidneys remove excess sugar from the body, and protects heart.
This is particularly important because heart disease is the leading cause of death in people with type 2 diabetes.
The guidance also recommends that people should be given a slow-release form of metformin, instead of standard-release form, which could lead to stomach upsets in some people.
Thus, the slow-release version will help people stay on their treatment.
NHS saving
The NHS will be saving millions of pounds as one of the most commonly prescribed SGLT-2 medicines, dapagliflozin, as its generic version is now available.
The estimated cumulative savings in total for 2025/26 and 2026/27 from generic dapagliflozin would be £560 million.
Better diabetes care
NICE interim director of the centre for guidelines, Eric Power, described the new guidance as 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."
Douglas Twenefour, Head of Clinical at Diabetes UK said, "The shift towards a more personalised approach will help more people get the right treatment for them, at the right time. Monitoring the uptake of medicines, to ensure that those who could benefit receive them, will help address the unacceptable inequities in type 2 diabetes treatments and outcomes that still persist."
