Reviewing medicines

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.

1.22 Principles

1.22.1

When reviewing treatments, make a shared decision about changes with the person with type 2 diabetes. See the recommendations on involving people in medicine discussions. [2022, amended 2026]

1.22.2

Optimise their current treatment regimen before changing treatments, taking into account factors such as:

adverse effects
prescribed doses and formulations
adherence to, and management of existing medicines
the need to revisit advice about diet and healthy living.

See also the recommendations on individualised care. [2022, amended 2026]

1.22.3

If response to medicines suggests that type 2 diabetes might not be the correct diagnosis, see the recommendations on initial diagnosis and revisiting initial diagnosis in NICE's guideline on managing type 1 diabetes. [2026]

1.23 Reviewing metformin

1.23.1

For adults with type 2 diabetes who are already taking standard-release metformin:

continue with this treatment or
switch to modified-release metformin if standard-release metformin is not tolerated or if this is the person's preference. [2026]

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 reviewing medicines.

Full details of the evidence and the committee's discussion are in:

1.24 Reviewing other medicines

1.24.1

If the person has reached their individualised glycaemic target and weight target (as defined in the section on discussing results and referral in NICE's guideline on overweight and obesity), consider continuing any medicines that have contributed to this. [2026]

1.24.2

Consider continuing SGLT-2 inhibitors for their cardiovascular or renal benefits, even if they do not help the person reach their individualised glycaemic targets. [2026]

1.24.3

Stop GLP-1 receptor agonists or tirzepatide if the person becomes underweight (BMI under 18.5 kg/m²). [2026]

1.24.4

Stop GLP-1 receptor agonists or tirzepatide if they do not help the person reach their individualised glycaemic targets and they are not being taken for their cardiovascular benefits. [2026]

1.24.5

Take into account adverse effects from combining medicines (for example hypoglycaemia). [2022, amended 2026]

1.24.6

Do not offer both a GLP-1 receptor agonist or tirzepatide and a DPP-4 inhibitor together to treat type 2 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 reviewing medicines.

Full details of the evidence and the committee's discussion are in: