Diabetes Ther. 2026 Jul 13. doi: 10.1007/s13300-026-01889-x. Online ahead of print.
ABSTRACT
The latest type 2 diabetes mellitus (T2DM) management guidelines from the UK National Institute for Health and Care Excellence (NICE; NG28) have raised the profile of sodium-glucose cotransporter-2 inhibitors (SGLT2is) so that they are now the preferred first-line therapy in combination with modified-release metformin (or as monotherapy where metformin is contraindicated/not tolerated) for most individuals. Previous NICE recommendations limited use to those with high cardiovascular disease (CVD) risk or existing CVD and/or kidney disease for first-line treatment or people with a need for additional glycaemic optimisation at later stages in the pathway. This change brings the guidelines in line with other national and international recommendations regarding SGLT2i use for the achievement and maintenance of glycaemic targets and lowering of progressive risk for cardiovascular, renal and metabolic (CVRM) complications. Yet, despite a plethora of evidence supporting the role that SGLT2is can play in sustaining long-term health outcomes in people with T2DM, prescribing data from real-world clinical practice show that these therapies are under-prescribed, particularly among those populations most likely to benefit from their use (including individuals with CVD or high CVRM risk). This latest narrative review from the Improving Diabetes Steering Committee examines the place of SGLT2is within the latest NG28 guidelines and likely reasons for suboptimal SGLT2i use, providing pragmatic advice on appropriate approaches to initiation and management in daily practice and setting perceived risks into context against the potential benefits. Practical tools for healthcare professionals and people with T2DM are included, and the Committee's previously published SGLT2i Prescribing Decision Tool for T2DM Management has been updated and aligned with the most recent guidelines with the aim of providing a helpful and high-quality quick reference resource.
PMID:42440015 | DOI:10.1007/s13300-026-01889-x