Earlier SGLT-2 inhibitors for type 2 diabetes could cut deaths, says NICE

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Earlier SGLT-2 inhibitors for type 2 diabetes could cut deaths, says NICE

Doctor checking blood glucose level using a fingerstick glucose meter, waiting for results from glucometer. Obese or overweight man at risk of developing type 2 diabetes. Concept of health risks of overwight and obesity. — image: ©Halfpoint | iStock

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New guidance from NICE recommends earlier use of SGLT-2 inhibitors and personalised treatment for people with type 2 diabetes, potentially reducing deaths and protecting heart and kidney health while saving the NHS millions

According to NICE analysis, the updated recommendations could prevent thousands of deaths over the next few years, improve protection for the heart and kidneys, and generate NHS savings through the use of generic medicines, marking one of the most significant shifts in diabetes treatment in recent years.

Impact of earlier use of SGLT-2 inhibitors

One of the most commonly prescribed SGLT-2 inhibitors, dapagliflozin, is now available as a generic equivalent. This could save a total of £ 560 million in 2025/26 and 2026/27. The money could be reinvested into other areas of diabetes care or other parts of the NHS.

Analysis suggests that using SGLT-2 medicines earlier in the treatment pathway, and the introduction of GLP-1 receptor agonists and tirzepatide for some people, could prevent around 17,000 deaths over a three-year period across the UK by reducing the risk of heart attacks, strokes, and kidney problems.

SGLT-2 inhibitors help the kidneys remove excess sugar from the body. Research suggests they also protect the heart and kidneys, which is important as heart disease is the leading cause of death in people with type 2 diabetes.

Personalised diabetes care

Mostly, newly diagnosed diabetes patients are started on a medicine called metformin. The new NICE guidance now recommends that most people should be offered metformin alongside an SGLT-2 inhibitor from the start. This approach should be personalised depending on individual circumstances and preferences. For example, people with obesity will have specific recommendations that account for their needs, and those over 40 may benefit from adding another type of medicine called a GLP-1 receptor agonist, such as tirzepatide.

NICE analysed anonymised records of almost 590,000 people and found that SGLT-2 inhibitors are not being prescribed fairly across all populations, with significant underprescribing to women, older people, and Black people. The new guidance directly addresses this inequity by recommending steps to ensure all eligible patients can access SGLT-2 inhibitors, supporting fairer treatment for everyone with type 2 diabetes.

“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,” said Eric Power, interim director of the centre for guidelines at NICE.

He added, “However, these life-saving medicines are under-prescribed to women, older people and Black patients. Our recommendations aim to ensure fair access to the best available treatments for everyone with type 2 diabetes.”

“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.”

“This welcome guidance will transform treatment for people living with type 2 diabetes across the UK. Providing earlier access to vital drugs that protect the heart and kidneys from serious diabetes-related complications is a major step towards reducing the harm caused by this relentless condition,” added Douglas Twenefour, Head of Clinical at Diabetes UK.

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