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Diabetes: metformin and SGLT-2 inhibitors (early onset T2DM)
GID-IND10349: The percentage of patients with type 2 diabetes under the age of 40 who are currently treated with metformin and an SGLT-2 inhibitor.
Indicator type
General practice indicator suitable for use in the QOF
Rationale
Management of type 2 diabetes can improve health holistically by offering cardiovascular protection as well as blood glucose control.
People with early onset type 2 diabetes have a very high lifetime risk of cardiovascular disease and renal complications, and of dying from them. Early intensive treatment can provide benefits by preventing these negative outcomes.
Source guidance
Type 2 diabetes in adults: management. NICE guideline NG28 (2015, updated 2026), recommendations 1.16.1, 1.16.2, 1.20.1, 1.20.2 and 1.23.1.
Specification
Numerator: The number of patients in the denominator who are currently treated with metformin and an SGLT-2 inhibitor
Denominator: The number of patients with type 2 diabetes under the age of 40 years.
Definition: Current treatment is defined as a prescription in the last 6 months of the reporting period.
Exclusions:
People under 18 years.
People with eGFR less than 20 ml/min/1.73 m2.
Personalised care adjustments or exception reporting should be considered for each medicine to account for situations where the patient declines or if treatment is inappropriate.
Question for consultation:
17. This indicator focuses on early-onset type 2 diabetes because of the lifetime risk of cardiovascular disease and renal complications associated with type 2 diabetes. Data from the National Diabetes audit suggests the number of adults with type 2 diabetes under the age of 40 in England is sufficient to support an indicator in this area. Is there variation in numbers of people with early onset type 2 diabetes between practices?
18. Is there likely to be a significant population who would need to be excluded from measurement using personalised care adjustments because:
both medicines are unsuitable or contraindicated
they do not choose medicines for management of their diabetes
medicines are no longer used for management of their diabetes?
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