PATIENTS with type 2 diabetes in the UK will now be offered sodium-glucose co-transporter 2 (SGLT-2) inhibitors much earlier in the treatment process, in line with updated guidance from the National Institute for Health and Care Excellence (NICE).
NICE analysis suggests that this could prevent around 17,000 deaths across the UK over a 3-year period by reducing the risk of heart attacks, strokes and kidney problems.
SGLT-2 Inhibitors as First-Line Treatment
The standard first-line treatment for people newly diagnosed with type 2 diabetes is metformin. The new guidance recommends that it should now be metformin with an SGLT-2 inhibitor.
SGLT-2 inhibitors lower blood sugar levels and have been shown in clinical trials to have a protective effect on the kidneys and the heart, reducing the chance of premature death from cardiac events.
Further, one of the most prescribed SGLT-2 medicines, dapagliflozin, is now available as a clinically equivalent generic version. Estimated NHS savings for 2025/26 and 2026/27 for generic dapagliflozin could be 560 million GBP.
NICE Consultation
A 2026 trial emulation in UK primary care data, submitted as part of the NICE consultation process, analysed data from 60,000 people in the UK.
It found that people with type 2 diabetes who were prescribed SGLT-2 inhibitors were 24% less likely to have a premature death over an average of 3 years than those given an alternative blood sugar-lowering drug.
Patient-Centred Approaches
The new guidance recommends monitoring patients who receive the treatment, following a NICE examination of almost 590,000 anonymised records that found SGLT-2 inhibitors are often under prescribed to women, older people, and Black people.
The guidance also encourages healthcare professionals to take a patient-centred approach. It stated that professionals should check each patient’s heart and kidney health before starting treatment and new medications should be introduced one at a time to ensure they are well tolerated.
For example, people diagnosed with type 2 diabetes before the age of 40 have a higher lifetime risk of heart and kidney problems, so many benefit from having a GLP-1 receptor agonist or tirzepatide added to their treatment plan.
People with obesity have specific recommendations and will also be recommended GLP-1 receptor agonists. Semaglutide will also now be recommended for people with type 2 diabetes who have cardiovascular disease caused by blocked arteries.
SGLT-2 inhibitors offer people with pre-existing kidney disease or heart failure particular benefits.
References
National Institute for Health and Care Excellence (NICE). Type 2 diabetes in adults: management. 2026. Available at: https://www.nice.org.uk/guidance/NG28. Last accessed 22 February 2026.
Ryan DK et al. Enhancing evidence-based care using trial emulation in electronic health records: real-world effects of empagliflozin in people with type 2 diabetes. BMJ Open Diabetes Res Care. 2026;14(1):DOI:10.1136/ bmjdrc-2025-005672.
National Institute for Health and Care Excellence (NICE). Women, older people and Black people less likely to receive a SGLT-2 inhibitor prescription for type 2 diabetes. Available at: https://www.nice.org.uk/news/articles/women-older-people-and-black-people-less-likely-to-receive-an-sglt-2-inhibitor-prescription-for-type-2-diabetes. Last accessed 22 February 2026.
