Update information

February 2026: We reviewed evidence on medicines for type 2 diabetes, for people with no relevant comorbidities as well as for people with common comorbidities.

We made new and updated recommendations on metformin, SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas and pioglitazone. These are marked [2026].

We made pragmatic changes without an evidence review to the recommendations on insulin, in the context of the withdrawal of insulin products and known insulin brand shortages.

We have also amended other recommendations without reviewing the evidence:

In the section on dietary advice, we have added a link to NICE's guideline on overweight and obesity management. We have also added links throughout to the NHS Type 2 diabetes Path to Remission Programme.
Some recommendations have been amended to align them with the new medicine recommendations. This includes recommendations on HbA1c targets, that now refer to an 'initial medication regimen' rather than a 'single drug', and recommendations on introducing or reviewing medicines, that now reflect the updated medicine pathway.
We have updated terminology throughout the guideline so that recommendations now refer to 'living with overweight' rather than 'being overweight' and to 'healthy living' rather than 'lifestyle'.

These amended recommendations are marked [2009, amended 2026], [2015, amended 2026] and [2022, amended 2026].

June 2022: We reviewed evidence on periodontitis in people with type 2 diabetes and made new recommendations. These recommendations are marked [2022].

March 2022: We reviewed the evidence on continuous glucose monitoring for adults with type 2 diabetes. These recommendations are marked [2022].

We also made one change without an evidence review: in the section on self-monitoring of capillary blood glucose, the word 'capillary' has been added to the heading and recommendations, to make it clear that recommendations apply to adults who are using capillary blood glucose monitoring rather than CGM. These recommendations are marked [2015, amended 2022].

Recommendations are marked to show when they last had an evidence review, for example [2009] or [2015]. In some cases, minor changes have been made to the wording to bring the language and style up to date, without changing the meaning.

February 2022: We reviewed the evidence and made new recommendations on drug treatment for adults with type 2 diabetes. These recommendations are marked [2022].

In recommendation 1.1.1 we have removed 'because of reduced life expectancy'. This change was made without an evidence review.

These recommendations are marked [2015, amended 2022].

November 2021: We reviewed the evidence and made new recommendations on SGLT2 inhibitors for adults with type 2 diabetes and chronic kidney disease. They are marked [2021].

December 2020: We amended recommendations in the section on eye disease to bring them in line with the diabetic eye screening programme. The evidence for these recommendations has not been reviewed, and they are marked [2009, amended 2020].

August 2019: The recommendations on diagnosing and managing hypertension have been removed because diagnosis, treatment and monitoring of hypertension is broadly the same for people with type 2 diabetes as for other people (see the NICE guideline on hypertension in adults). When a different approach is needed for people with type 2 diabetes, this is specified in the hypertension guideline.

December 2015: We updated and replaced NICE guideline CG87 (published May 2009) and NICE technology appraisal guidance 203 and 248. We made a change without an evidence review. The recommendation on the treatment of gastroparesis was replaced by recommendations from the NICE guideline on type 1 diabetes. This change is labelled [2015].

Minor changes since publication

March 2025: Links were updated following publication of NICE's guideline on overweight and obesity management.

August 2024: We added a link to NICE's guideline on diabetic retinopathy in the section on complications.

August 2022: We added a new recommendation to the section on reviewing drug treatments, to clarify what to do for adults who start taking an SGLT2 inhibitor before they are 40. This recommendation is marked [2022].

We also updated the visual summary following stakeholder feedback. See the tables on summary of first-line medicines and on summary of medicines for further treatment.

May 2022: We added a link to NICE's guideline on medicines associated with dependence or withdrawal symptoms in the section on autonomic neuropathy.

December 2019: Relationships to the NICE guideline on hypertension were clarified, and a link was added to the decision aid on choice of medicine to control blood glucose.

June 2018: A recommendation was added to link to NICE's advice on bariatric surgery.

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