New Diabetes Treatment Guidelines to Save Lives and NHS Funds
Major changes to type 2 diabetes treatment are set to improve outcomes for millions and potentially save the National Health Service (NHS) £560 million over the next two years. New guidance from the National Institute for Health and Care Excellence (NICE) recommends offering a class of medications called SGLT-2 inhibitors, often referred to as ‘flozins,’ earlier in the treatment pathway.
A Shift in Treatment Approach
Until recently, most individuals newly diagnosed with type 2 diabetes were initially prescribed metformin. The updated NICE guidance now suggests that most patients should begin treatment with both metformin and an SGLT-2 inhibitor simultaneously. This represents a move away from a “one-size-fits-all” approach, tailoring recommendations to individual patient circumstances.
How SGLT-2 Inhibitors Operate
SGLT-2 inhibitors function by assisting the kidneys in removing excess sugar from the body. However, research indicates these medications offer benefits beyond blood sugar control, actively protecting the heart and kidneys 1. This is particularly significant as heart disease is the leading cause of death among people with type 2 diabetes.
Expanding Access to Other Medications
Alongside the changes to SGLT-2 inhibitor prescriptions, access to GLP-1 receptor agonists (such as semaglutide, dulaglutide, and liraglutide) and tirzepatide has also been expanded. These medications are now recommended for individuals diagnosed with type 2 diabetes before the age of 40, those with cardiovascular disease caused by blocked arteries, or those living with obesity 1.
Financial Benefits and Reinvestment
The increased use of generic dapagliflozin, a commonly prescribed SGLT-2 inhibitor, is expected to generate cumulative savings of £560 million for the NHS over 2025/26 and 2026/27 2. NICE suggests these funds could be reinvested into other areas of diabetes care, such as education programs and community support services, or allocated to other parts of the NHS.
Potential to Prevent Thousands of Deaths
Analysis by NICE indicates that earlier use of SGLT-2 medications, combined with the introduction of GLP-1 receptor agonists and tirzepatide for eligible patients, could prevent approximately 17,000 deaths over a three-year period across the UK by reducing the risk of heart attacks, strokes, and kidney problems 2, 1.
Improved Metformin Tolerance
The guidance also recommends the use of slow-release metformin formulations. Standard-release metformin can cause stomach upset in some patients, leading to discontinuation of treatment. The slow-release version is gentler on the stomach, improving treatment adherence 1.
“This is a landmark moment for diabetes care,” said Eric Power, NICE’s interim director of the centre for guidelines. “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.”
“This welcome guidance will transform treatment for people living with type 2 diabetes across the UK,” added Douglas Twenefour, head of clinical at Diabetes UK.
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