NICE recommends overhaul of type 2 diabetes treatment

Under new draft guidance from NICE, treatment for people living with type 2 diabetes will move away from a “one-size-fits-all” approach. Instead, it recommends personalised treatment plans that aim to prevent serious complications, aligning with one of the aims of the 10-Year Health Plan for the NHS.

Because of their cardiorenal protective benefits, NICE’s independent guideline committee now recommends offering an SGLT2 inhibitor as first-line treatment for adults alongside metformin at diagnosis, even when there are no significant comorbidities. If metformin is not tolerated or is contraindicated, an SGLT2 inhibitor can be offered as monotherapy.

Additionally, for people with type 2 diabetes and atherosclerotic cardiovascular disease, or for adults with early onset type 2 diabetes, the introduction of a GLP-1 receptor agonist is recommended as an option earlier in the treatment pathway.

NICE states that offering treatments that will reduce people’s future risk of ill health is a smarter way for the NHS to spend money. It also believes that the recommendations will help tackle health inequity, citing evidence that SGLT2 inhibitors are under-prescribed to women, older people, and Black or Black British individuals.

There are also special recommendations for adults with frailty and for those who do better with fewer medications. For these people, metformin would be offered or, if that was unsuitable, a DPP-4 inhibitor could be considered.

The draft guideline, which is open for consultation until Thursday 2 October, can be read here.