NICE widens access to SGLT - 2 inhibitors and GLP - 1s in updated type 2 diabetes guidance

pharmaceutical-journal.com · Feb 18, 2026 · Collected from GDELT

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The National Institute for Health and Care Excellence highlighted research which showed that sodium–glucose co-transporter-2 inhibitors actively protect the heart and kidneysLucigerma/Shutterstock.comNewly diagnosed patients with type 2 diabetes mellitus (T2DM) should be offered a sodium–glucose co-transporter-2 (SGLT-2) inhibitor – which include dapagliflozin and empagliflozin – earlier in their treatment alongside metformin, updated guidance from the National Institute for Health and Care Excellence (NICE) has said.In guidance published on 18 February 2026, NICE said that research has shown that SGLT-2 inhibitors not only control blood sugar but actively protect the heart and kidneys, which is important because heart disease is the leading cause of death in people with T2DM.Previous guidance recommended treatment only with metformin.NICE said the change could prevent around 17,000 deaths over three years across the UK.Access to GLP-1 receptor agonists, such as semaglutide, dulaglutide and liraglutide, and the related medicine tirzepatide, has also been significantly expanded in the guidance.According to the guidance, GLP-1 receptor agonists will now be recommended for people with T2DM who have cardiovascular disease (CVD) caused by blocked arteries, those diagnosed with T2DM before the age of 40, or those living with obesity.Around 810,000 more people could become eligible as a result, NICE said.The guidance also recommends that people should be given a slow-release metformin, as stomach side effects from the standard-release form are a common reason patients stop taking it.Commenting on the guidance, Philip Newland-Jones, consultant pharmacist in diabetes and endocrinology at the University of Southampton, said it brought NICE recommendations in line with other international guidelines with “a less glucose-centric approach, focusing on cardiovascular risk and obesity along with prevention of small vessel complications linked with glucose exposure,” noting that this is “fantastic” for people living with T2DM.“The focus on equity of access to SGLT-2 inhibitors and widened eligibility of GLP-1 receptor agonists for CVD and early onset T2DM are… very welcome additions… along with modified-release metformin now recognised as standard treatment,” he added.NICE said that one of the most commonly prescribed SGLT-2 medicines, dapagliflozin, is now available as a generic, which could save the NHS an estimated £560m across 2025/2026 and 2026/2027.Mark Samuels, chief executive of Medicines UK, said: “This is a very welcome development, which will make a critical impact. With generic competition, dapagliflozin’s use will significantly grow, and from September 2026, it is likely that prescriptions will rise in number by 230% to treat 2.4 million people.“This is a strong example of how replacing end-of-patent medicines with generic ones can increase patient access significantly while still saving the NHS money. If the government is going to spend more money on medicines, this spend needs to derive full value now by lowering NHS costs and keeping patients healthy, productive and out of hospital.”NICE also found that SGLT-2 inhibitors are currently underprescribed to women, older people and black patients, based on analysis of records from almost 590,000 patients. The new guidance includes recommendations to monitor prescribing and close these gaps.Douglas Twenefour, head of clinical at Diabetes UK, said: “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. “The shift towards a more personalised approach will help more people get the right treatment for them, at the right time. Monitoring the uptake of medicines, to ensure that those who could benefit receive them, will help address the unacceptable inequities in T2DM treatments and outcomes that still persist.” Last updated 18 February 2026 15:36CitationThe Pharmaceutical Journal, PJ February 2026, Vol 317, No 8006;317(8006)::DOI:10.1211/PJ.2026.1.400377