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.
See the visual summary for an overview of the recommendations and additional information to support medicine choice up to the point at which a person starts insulin-based treatment.
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.
SGLT-2 inhibitors and GLP-1 receptor agonists are recommended as much for their cardiovascular and renal benefits as for their glycaemic benefits (unless otherwise specified).
Healthcare professionals should also refer to the summary of product characteristics for individual medicines for contraindications and precautions to take in pregnancy and breastfeeding and for women, trans men and non-binary people of childbearing potential.
For adults with type 2 diabetes and no relevant comorbidity who need further medicines to reach their individualised glycaemic targets:
offer to add a DPP-4 inhibitor to their current treatment
if this is contraindicated, not tolerated or is not effective, offer to add:
a sulfonylurea or
pioglitazone or
an insulin-based treatment (see the section on insulin-based treatments). [2026]
For a short explanation of why the committee made the 2026 recommendation and how it might affect practice, see the rationale and impact section on treatment options if further medicines are needed for people with no relevant comorbidity.
Full details of the evidence and the committee's discussion are in:
For adults with type 2 diabetes and heart failure who need further medicines to reach their individualised glycaemic targets:
offer to add a DPP-4 inhibitor to their current treatment
if this is contraindicated, not tolerated or not effective, offer to add:
a sulfonylurea or
an insulin-based treatment (see the section on insulin-based treatments). [2026]
For a short explanation of why the committee made the 2026 recommendation and how it might affect practice, see the rationale and impact section on treatment options if further medicines are needed for people with type 2 diabetes and heart failure.
Full details of the evidence and the committee's discussion are in:
If an adult with type 2 diabetes develops atherosclerotic cardiovascular disease after starting initial treatment, offer to add subcutaneous semaglutide (Ozempic), up to 1 mg once a week, to their current treatment, for its cardiovascular and renal benefits. [2026]
For adults with type 2 diabetes and atherosclerotic cardiovascular disease who need further medicines to reach their individualised glycaemic targets, offer to add to their current treatment:
a sulfonylurea or
pioglitazone or
an insulin-based treatment (see the section on insulin-based treatments). [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 treatment options if further medicines are needed for people with atherosclerotic cardiovascular disease.
Full details of the evidence and the committee's discussion are in:
For adults with early onset type 2 diabetes who need further medicines to reach their individualised glycaemic targets, consider adding a GLP-1 receptor agonist or tirzepatide. [2026]
For adults with early onset type 2 diabetes who need further medicines to reach their individualised glycaemic targets and for whom a GLP-1 receptor agonist or tirzepatide is contraindicated, not tolerated or not appropriate:
offer to add a DPP-4 inhibitor to their current treatment
if this is contraindicated, not tolerated or is not effective, offer to add:
a sulfonylurea or
pioglitazone or
an insulin-based treatment (see the section on insulin-based treatments). [2026]
For adults with early onset type 2 diabetes who need further medicines to reach their individualised glycaemic targets and are taking a GLP-1 receptor agonist or tirzepatide, offer to add to their current treatment:
a sulfonylurea or
pioglitazone or
an insulin-based treatment (see the section on insulin-based treatments). [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 treatment options if further medicines are needed for people with early onset type 2 diabetes.
Full details of the evidence and the committee's discussion are in:
If considering medicines primarily for weight management, see information about medicines for overweight and obesity in NICE's guideline on overweight and obesity management. [2026]
Consider adding a GLP-1 receptor agonist or tirzepatide for adults with type 2 diabetes who are living with obesity, if:
they have been taking initial therapy for at least 3 months and
further medicines are needed to reach their individualised glycaemic targets and
they are not already taking a GLP-1 receptor agonist or tirzepatide.
For a definition of obesity, see the section on classifying overweight and obesity in adults in NICE's guideline on overweight and obesity management. [2026]
For adults with type 2 diabetes who are living with obesity who need further medicines to reach their individualised glycaemic targets and for whom a GLP-1 receptor agonist or tirzepatide is contraindicated, not tolerated, not appropriate or not effective:
offer to add a DPP-4 inhibitor to their current treatment
if this is contraindicated, not tolerated or not effective, offer to add:
a sulfonylurea or
pioglitazone or
an insulin-based treatment (see the section on insulin-based treatments). [2026]
For adults with type 2 diabetes who are living with obesity who need further medicines to reach their individualised glycaemic targets and are already taking a GLP-1 receptor agonist or tirzepatide, offer to add:
a sulfonylurea or
pioglitazone or
an insulin-based treatment (see the section on insulin-based treatments). [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 treatment options if further medicines are needed for people with type 2 diabetes living with obesity.
Full details of the evidence and the committee's discussion are in:
Medicines vary in their contraindications and precautions for use in people with renal impairment. See NICE's information on prescribing medicines and refer to the summary of product characteristics for individual products.
For adults with type 2 diabetes and chronic kidney disease who need further medicines to reach their individualised glycaemic targets:
consider adding a DPP-4 inhibitor
if they are already taking a DPP-4 inhibitor or if a DPP-4 inhibitor is contraindicated, not tolerated or not effective, consider adding:
pioglitazone or
a sulfonylurea (if their eGFR is above 30 ml/min/1.73 m2) or
an insulin-based treatment. [2026]
For a short explanation of why the committee made the 2026 recommendation and how it might affect practice, see the rationale and impact section on treatment options if further medicines are needed for people with type 2 diabetes and chronic kidney disease.
Full details of the evidence and the committee's discussion are in:
For adults with frailty who need further medicines to manage their hyperglycaemia symptoms and reach their individualised glycaemic targets:
consider adding a DPP-4 inhibitor to their current treatment or
if they are already taking a DPP-4 inhibitor or if a DPP-4 inhibitor is contraindicated, not tolerated or is not effective, consider adding 1 of the following to their current treatment:
pioglitazone or
a sulfonylurea or
an insulin-based treatment (see the section on insulin-based treatments). [2026]
When choosing a treatment with the person, take into account that sulfonylureas and insulin-based treatments can increase the risk of hypoglycaemia and falls. [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 treatment options if further medicines are needed for people with type 2 diabetes and frailty.
Full details of the evidence and the committee's discussion are in: