Earlier SGLT-2 inhibitor use could prevent 17,000 deaths, NICE guidance says
New NICE guidance recommends offering SGLT-2 inhibitors earlier in type 2 diabetes treatment, potentially preventing 17,000 deaths over three years while saving the NHS £560 million through generic medicines.
The National Institute for Health and Care Excellence (NICE) has published final guidance recommending that many patients with type 2 diabetes be offered SGLT-2 inhibitors earlier in their treatment, alongside personalised care plans. 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.
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.
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.
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.
The interim director of the centre for guidelines at NICE said the independent committee conducted a rigorous review of the evidence and concluded that by offering certain medicines earlier, thousands of heart attacks, strokes and cases of kidney failure can be prevented, keeping people healthier for longer while reducing pressure on NHS services. The guidance aims to ensure fair access to the best available treatments for everyone with type 2 diabetes while freeing up hundreds of millions of pounds that can be reinvested elsewhere in NHS care.