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Source
NICE
Published
25 Mar 2026
Last Indexed
25 Mar 2026
Specialty
Diabetes / Metabolic
NICE NG28 (updated 2024) provides updated guidance on management of type 2 diabetes including revised treatment algorithm with emphasis on SGLT2 inhibitors and GLP-1 receptor agonists for cardiorenal protection.
Key Recommendations
- Offer metformin as first-line unless eGFR <30 or contraindicated
- Add SGLT2 inhibitor if established CVD, heart failure, or CKD (regardless of HbA1c)
- Add GLP-1RA if SGLT2 inhibitor contraindicated and BMI ≥35 with CVD, or BMI ≥30 with high CVD risk
- HbA1c target: 48 mmol/mol (6.5%) drug-naive; 53 mmol/mol (7.0%) on one drug
- Review sulfonylureas — consider switching to SGLT2i or GLP-1RA where appropriate
- Discuss weight management at every review — semaglutide 2.4mg licensed for obesity
- Annual review: HbA1c, eGFR, urine ACR, blood pressure, retinal screening, foot exam
ClinicalIQ Editorial Note: This guideline summary is indexed from NICE. Always refer to the full guideline for complete recommendations. Last indexed: 25 Mar 2026