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    Diabetes: metformin, SGLT-2 inhibitors and semaglutide (T2DM and CVD)

    GID-IND10348: The percentage of patients with type 2 diabetes and cardiovascular disease (CVD) who are currently treated with:

    • metformin, and

    • an SGLT-2 inhibitor, and

    • subcutaneous semaglutide.

    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. 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. Subcutaneous semaglutide (Ozempic), up to 1 mg once a week also makes a clinically important reduction to risk of major cardiovascular events, HbA1c and weight.

    Source guidance

    Type 2 diabetes in adults: management. NICE guideline NG28 (2015, updated 2026), recommendations 1.15.1, 1.15.2, 1.19.1, 1.19.2, 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, and

    • subcutaneous semaglutide.

    Denominator: The number of patients with type 2 diabetes and CVD.

    Definition:

    • CVD is defined as angina, previous myocardial infarction, revascularisation, ischaemic stroke or TIA, or symptomatic peripheral arterial disease.

    • Current treatment is defined as a prescription in the last 6 months of the reporting period.

    • NICE's guideline on type 2 diabetes in adults recommends subcutaneous semaglutide (Ozempic), up to 1 mg once a week, for its cardiovascular, renal and glycaemic benefits for adults with type 2 diabetes and atherosclerotic cardiovascular disease. However, this indicator allows for patients to be included in the numerator if they are prescribed a higher dose of subcutaneous semaglutide for management of another condition.

    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:

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

    • all 3 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?

    20. The current draft T2DM indicators do 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?

    21. Current treatment is defined as a prescription in the last 6 months of the reporting period. Is this long enough for introduction of 3 medicines?