Major update to type 2 diabetes care
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NICE has released draft guidelines proposing the most significant change to type 2 diabetes treatment in over a decade. The update moves away from a “one-size-fits-all” model and towards more personalised care, with a stronger focus on preventing heart and kidney complications.
Key changes include:
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Earlier use of newer medicines – SGLT-2 inhibitors (such as canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin) are now recommended as first-line options alongside metformin, rather than being kept for later.
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More tailored treatment plans – GLP-1 receptor agonists (e.g. liraglutide, semaglutide) are recommended earlier for some groups, particularly those with cardiovascular disease or obesity.
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Individualised care – Treatment will vary depending on age, frailty, kidney function, or other health conditions. For example, those who cannot take metformin may start directly on an SGLT-2 inhibitor.
NICE estimates that adopting these recommendations could prevent thousands of deaths, while also tackling inequalities in prescribing – particularly among women, older adults, and people from Black or disadvantaged communities.
The proposals are open for public consultation until 2 October 2025, before final guidance is published.
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