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Practice Guidelines

Type 2 diabetes: summary of updated NICE guidance

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o775 (Published 18 May 2022) Cite this as: BMJ 2022;377:o775
  1. Gregory M Moran, medicines analyst1,
  2. Chirag Bakhai, general practitioner2,
  3. Soon H Song, consultant diabetologist3,
  4. Juliana Chizo Agwu, committee chair and consultant paediatrician in diabetes and endocrinology4
  5. on behalf of the Guideline Committee
  1. 1National Institute for Health and Care Excellence (NICE), City Tower, Piccadilly Plaza, Manchester M1 4BT, UK
  2. 2Bedfordshire, Luton and Milton Keynes Clinical Commissioning Group, Capability House, Bedford MK45 4HR, UK
  3. 3Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield S5 7AU, UK
  4. 4Sandwell and West Birmingham NHS Trust, Sandwell General Hospital, West Bromwich B71 4HJ, UK
  1. Correspondence to: G M Moran Gregory.moran{at}nice.org.uk

What you need to know

  • When assessing or reviewing adults with type 2 diabetes, include an assessment of the person’s cardiovascular status and cardiovascular risk

  • Assess the lifetime risk of cardiovascular disease in people with type 2 diabetes aged <40 years, instead of 10-year cardiovascular risk

  • Offer adults with type 2 diabetes who have chronic heart failure or atherosclerotic cardiovascular disease a sodium-glucose transport protein 2 (SGLT2) inhibitor with proven cardiovascular benefit

  • Consider an SGLT2 inhibitor in adults with type 2 diabetes who have do not have chronic heart failure or atherosclerotic cardiovascular disease but who have an increased cardiovascular risk

  • If an SGLT2 inhibitor is indicated and no glucose lowering drugs are already being taken, it should be prescribed in combination with metformin as soon as metformin tolerability is confirmed

  • Check and address modifiable risks for diabetic ketoacidosis before starting treatment with an SGLT2 inhibitor

The National Institute for Health and Care Excellence (NICE) last updated the drug treatment section of the type 2 diabetes guideline in 2015. Since then, further evidence on drug treatment from randomised trials investigating the effects of glucose lowering drugs on cardiovascular outcomes has emerged, prompting a further update. This article summarises the most recent recommendations on drug treatment of type 2 diabetes from the NICE guideline.1 This rapid update focuses on evidence of cardiovascular outcomes, with a full update of the section now under way. Key changes to current practice include new recommendations for the use of sodium glucose co-transporter 2 (SGLT2) inhibitors in adults with type 2 diabetes who have chronic heart failure or established atherosclerotic cardiovascular disease or who are at high risk of developing cardiovascular disease. New recommendations for adults with type 2 diabetes and chronic kidney disease were added to the guideline in 2021 but are not covered in this article.

Recommendations

NICE recommendations …

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