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In updated guidance published today (February 18) NICE now recommends that people with type 2 diabetes should be offered modified-release metformin, plus an SGLT-2 inhibitor as initial therapy. 

Until now, initial therapy for most people with newly diagnosed type 2 diabetes was standard-release metformin alone. 

However, analysis by NICE suggests 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.

Eric Power, interim director of the centre for guidelines at NICE said: "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."

The guidance also expands access to GLP-1 receptor agonists and tirzepatide. Semaglutide is now recommended for people with type 2 diabetes who also have cardiovascular disease caused by blocked arteries (such as previous heart attacks or strokes). GLP-1 receptor agonists and tirzepatide are recommended for people who were diagnosed before age 40, or who are living with obesity.

A visual summary Type 2 diabetes in adults: choosing medicines for first line and further treatment is available on the NICE website.