This guideline covers the care and management of type 2 diabetes in adults (aged 18 and over). It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications.

In May 2017 we added text on sodium–glucose cotransporter 2 (SGLT-2) inhibitors to the section on initial drug treatment. We also updated the algorithm for blood glucose lowering therapy in adults with type 2 diabetes to revise footnote b with links to relevant NICE guidance on SGLT-2 inhibitors, and added new information on SGLT-2 inhibitors to the box on action to take if metformin is contraindicated or not tolerated.


This updated guideline includes new recommendations on:

Who is it for?

  • Healthcare professionals that care for adults with diabetes
  • Commissioners and providers of diabetes services
  • Adults with type 2 diabetes, and their families and carers

Is this guideline up to date?

In July 2017, NICE reviewed the evidence on the effectiveness and impact of drugs used to manage diabetes in people with a high risk of cardiovascular disease.

NICE found that there was insufficient evidence to make further recommendations, as trials have only reported on some of the drugs in the SGLT-2 and GLP-1 classes, with trials of others still ongoing. The recommendations remain unchanged.  As new trial evidence becomes available NICE will consider the need to update this guidance. For further information, see the evidence reviews

Guideline development process

How we develop NICE guidelines

This guideline updates and replaces NICE guideline CG87 (May 2009), NICE guideline CG66 (May 2008), NICE technology appraisal guidance 248 (Febraury 2012) and NICE technology appraisal guidance 203 (October 2010).

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)