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    Diabetes: metformin and SGLT-2 inhibitors (T2DM)

    GID-IND10350: The percentage of patients with type 2 diabetes 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 type 2 diabetes have a higher risk of cardiovascular disease than people with the same health-related characteristics and no diabetes. Combining metformin with an SGLT-2 inhibitor is more clinically effective at reducing HbA1c, weight and cardiovascular events for people with type 2 diabetes than any other therapy combining metformin with 1 other medicine, and metformin alone.

    Source guidance

    Type 2 diabetes in adults: management. NICE guideline NG28 (2015, updated 2026), recommendations 1.13.1 to 1.19.2, 1.20.1, 1.20.2 and 1.23.1.

    Specification

    Numerator: The number in the denominator who are currently treated with metformin and an SGLT-2 inhibitor.

    Denominator: The number of patients with type 2 diabetes.

    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.

    Questions for consultation:

    14. Is there likely to be a significant population who would need to be excluded from measurement using personalised care adjustments (PCAs) 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?

    15. This draft indicator does not exclude people with moderate or severe frailty, unlike a number of current QOF indicators for diabetes (see indicators on BP, HbA1c and statins / LLT). We propose to use PCAs instead. Is this the right approach for frailty?

    16. We propose to exclude people with an eGFR less than 20 ml/min/1.73 m2 because the source guidance suggests that metformin and SGLT-2 inhibitors are not recommended for management of type 2 diabetes for people who have chronic kidney disease and an eGFR less than this. Is this approach appropriate or should this be considered for a PCA instead? This is also of relevance to the other 2 draft indicators on type 2 diabetes presented in this paper.