People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
Healthcare professionals should follow our general guidelines for people delivering care:
Read this guideline alongside the NHS Type 2 diabetes Path to Remission Programme.
Recommendations in this section that cover dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagonlike peptide-1 (GLP-1) receptor agonists, sulfonylureas and sodium–glucose cotransporter-2 (SGLT-2) inhibitors refer to each of these groups of medicines at class level.
For GLP-1 receptor agonists, at the time of publication (February 2026) this only includes liraglutide, dulaglutide, and semaglutide. For subcutaneous semaglutide (Ozempic), this only includes doses up to 1 mg once a week.
NICE has produced a visual summary that provides an overview of the recommendations and additional information to support medicine choice up to the point at which a person starts insulin-based treatment.
Discuss dietary advice and other aspects of healthy living, such as increasing physical activity, alongside medicines to support adults with type 2 diabetes with their personalised diabetes management plan. For more information on how to achieve this see the:
Discuss the benefits and risks of each medicine treatment option with adults with type 2 diabetes and support them to make an informed decision about their treatment. Take into account the:
effect of each medicine on HbA1c and weight
effectiveness of each medicine at preventing and managing cardiovascular and renal conditions
factors that might prevent the person from following a specific treatment option (for example, pioglitazone is contraindicated for people with heart failure)
cost: when more than 1 medicine from the same drug class are equally suitable for the person, use the least expensive. [2015, amended 2026]
See also NICE's guideline on shared decision making and the section on safety of medicines for diabetes before and during pregnancy in NICE's guideline on diabetes in pregnancy.
If a person has more than one comorbidity (for example, atherosclerotic cardiovascular disease and obesity), make a shared decision with them about which comorbidity to prioritise when choosing medicines. Take into account:
medicines required for cardiovascular and renal protection (for example, subcutaneous semaglutide for people with atherosclerotic cardiovascular disease)
medicines that are contraindicated (for example, metformin for people with chronic kidney disease and an eGFR of less than 30 mL/min/1.73 m2)
any other medicines they are taking and at what dose, particularly if the person has frailty (see recommendations for people with frailty in the initial medicines section).
See also the recommendations on individualised care and NICE's guideline on multimorbidity. [2026]
When discussing GLP-1 receptor agonists and tirzepatide with women, trans men and non-binary people of childbearing potential, tell them:
what Medicines and Healthcare products Regulatory Agency (MHRA) guidance on GLP-1 medicines for weight loss and diabetes says about the use of GLP-1 receptor agonists and tirzepatide in pregnancy and breastfeeding
weight loss may improve fertility
effective contraception must be used while taking the medicine
that if they want to become pregnant, they should continue to use contraception for a period after stopping the medication (see MHRA guidance on GLP-1 medicines for weight loss and diabetes for specific length of time). [2026]
Use non-judgemental language in all medication discussions to support people with starting and adhering to treatment. For guidance on this, see NHS England's guide to language and diabetes [2026]
For a short explanation of why the committee made the 2026 recommendations and how they might affect practice, see the rationale and impact section on involving people in medicine discussions.
Full details of the evidence and the committee's discussion are in
Give clear sick day rules in each person's individualised treatment plan. Depending on the person's needs and the medicines they are taking, these rules may need to specify:
whether medicine should change (and how) if the person is unwell or is having surgery
whether any medicines should be stopped if there is a risk of dehydration, vomiting and diarrhoea (relevant for metformin, SGLT-2 inhibitors)
how to adjust insulin doses
how to restart medication after recovery. [2026]
Follow the MHRA's safety advice on monitoring ketones during SGLT-2 inhibitor treatment interruption.
For a short explanation of why the committee made this 2026 recommendation and how it might affect practice, see the rationale and impact section on sick day rules.
Full details of the evidence and the committee's discussion are in:
Assess the person's current cardiovascular and renal status, and risk of developing cardiovascular disease in the future. [2022, amended 2026]
If frailty is a concern, assess for it before starting medicines.
See the recommendations on how to assess frailty in NICE's guideline on clinically assessing and managing multimorbidity. [2026]
For a short explanation of why the committee made the 2026 recommendations and how they might affect practice, see the rationale and impact section on assessing risk before starting medicines.
Full details of the evidence and the committee's discussion are in:
Commissioners, providers and healthcare professionals should address inequalities in SGLT-2 inhibitor access and uptake by:
monitoring who is using SGLT-2 inhibitors
identifying groups who are eligible but who have a lower uptake
making plans to engage with these groups to encourage them to use SGLT-2 inhibitors. [2026]
For a short explanation of why the committee made this 2026 recommendation and how they might affect practice, see the rationale and impact section on addressing inequalities in use of SGLT-2 inhibitors.
Full details of the evidence and the committee's discussion are in: