What are the latest recommendations for the management of type 2 diabetes with pharmacological agents in primary care?

For pharmacological management of type 2 diabetes in primary care, NICE recommends starting with standard-release metformin as first-line treatment for adults with type 2 diabetes ¹.

If metformin is contraindicated or not tolerated, consider an SGLT2 inhibitor with proven cardiovascular benefit, especially in patients with chronic heart failure or established atherosclerotic cardiovascular disease, or those at high risk of cardiovascular disease ¹.

When initiating dual therapy, introduce drugs sequentially, beginning with metformin, and then add an SGLT2 inhibitor once tolerability is confirmed ¹.

If monotherapy does not achieve the individual HbA1c target, consider adding a DPP-4 inhibitor, pioglitazone, a sulfonylurea, or an SGLT2 inhibitor, based on NICE guidance ¹.

For patients on dual therapy who still do not reach their HbA1c target, consider triple therapy with additional agents or insulin-based treatment ¹.

In adults with established cardiovascular disease or at high risk, SGLT2 inhibitors with proven cardiovascular benefit should be considered at any stage of treatment ¹.