The National Institute for Health and Care Excellence (NICE) has released draft guidance that could fundamentally transform type 2 diabetes treatment in England, Wales, and Northern Ireland, marking what officials call "the biggest shake-up" in diabetes care in a decade. The new recommendations prioritize personalized treatment approaches and earlier access to newer medications, including weight loss drugs, for millions of patients.
SGLT-2 Inhibitors Become First-Line Treatment
Under the new guidance, SGLT-2 inhibitors would become a first-line treatment option for type 2 diabetes patients, representing a significant departure from current practice. These once-daily tablets, which include canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin, work by helping the kidneys remove glucose through urine while providing additional cardiovascular and kidney protection.
NICE estimates that implementing this change could save almost 22,000 lives once uptake reaches 90% of the eligible population of approximately 2.3 million people. The recommendation comes after evidence demonstrated these drugs protect the heart and kidneys as well as control blood sugar levels.
"This guidance means more people will be offered medicines where it is right to do so to reduce their future risk of ill health," said Professor Jonathan Benger, deputy chief executive and chief medical officer at NICE. "We're moving beyond simply managing blood sugar to taking a holistic view of a person's health, particularly their cardiovascular and kidney health."
Addressing Prescribing Inequalities
NICE's analysis of 590,000 patient records revealed significant under-prescribing of SGLT-2 inhibitors, particularly affecting women, older people, and Black patients. Currently, only one in five people with type 2 diabetes and cardiovascular disease are prescribed these medications, despite their proven benefits.
Dr. Waqaar Shah, chairman of the guideline committee, emphasized the urgency of addressing these gaps: "We know that SGLT-2 inhibitors are currently under-prescribed, and our health economics analysis shows that people living in the most deprived areas would particularly benefit from universal access to these treatments."
The guidance specifically aims to reduce health inequalities while providing better outcomes across all patient populations, with prescribing the tablets to more people particularly benefiting those in poorer areas and ethnic minorities.
Expanded Access to GLP-1 Receptor Agonists
The draft guidance also recommends earlier access to GLP-1 receptor agonists such as liraglutide and semaglutide for specific patient groups, rather than reserving them for later stages of treatment. Under these recommendations, approximately 750,000 more people with type 2 diabetes would be offered these medications.
Semaglutide, marketed as Ozempic for diabetes treatment and Wegovy for weight management, would be offered sooner to adults with cardiovascular disease and some patients diagnosed with type 2 diabetes before age 40. These drugs serve dual purposes, lowering blood sugar levels while supporting weight loss in appropriate patients.
Tailored Treatment Approaches
The new guidance introduces several targeted treatment strategies based on patient characteristics and health conditions. Adults with cardiovascular disease would be offered triple therapy including a GLP-1 receptor agonist, while those diagnosed before age 40 would receive dual therapy before GLP-1 receptor agonist consideration. Patients with chronic kidney disease would receive tailored recommendations based on their specific kidney function.
Clinical Impact and Industry Response
The recommendations address a critical healthcare challenge, as cardiovascular disease represents the leading cause of death in people with type 2 diabetes. With approximately 4.6 million people in the UK living with diabetes—90% having type 2—and an estimated additional 1.3 million undiagnosed cases, the potential impact is substantial.
Douglas Twenefour, head of clinical at Diabetes UK, welcomed the announcement: "This long-awaited announcement propels type 2 diabetes treatment into the 21st century. The majority of people with type 2 diabetes are not currently taking the most effective medication for them, putting them at risk of devastating diabetes-related complications."
The draft guidance is currently under public consultation until October 2, with implementation expected to follow approval. The recommendations align with the NHS's long-term plan to reduce health inequalities and focus on preventing ill health, potentially transforming care for millions while reducing the condition's burden on healthcare systems.
