Quality statement 5: Treatment with an SGLT-2 inhibitor
Quality statement
Adults with type 2 diabetes are prescribed an SGLT-2 inhibitor. [2023, updated 2026]
Rationale
SGLT-2 inhibitors lower blood glucose and can reduce cardiovascular events and offer renal protection for adults with type 2 diabetes.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly. The quality measure measures prescribing of an SGLT-2 inhibitor for adults with type 2 diabetes but local services may want to adapt the measure to focus on prescribing for specific population groups, such as adults with type 2 diabetes and no relevant comorbidities or those comorbidities included in the NICE guideline. This could help to address inequality in prescribing.
Process
a) Proportion of adults with type 2 diabetes prescribed an SGLT-2 inhibitor.
Numerator – the number in the denominator who are prescribed an SGLT-2 inhibitor.
Denominator – the number of adults with type 2 diabetes.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Outcome
Prevalence of cardiovascular complications in adults with type 2 diabetes.
Data source: The National Diabetes Audit's report on complications and mortality includes data on the number of people with type 2 diabetes who are admitted to hospital with cardiovascular complications (angina, myocardial infarction, heart failure and stroke).
What the quality statement means for different audiences
Service providers (such as GP practices and secondary care providers) ensure that SGLT-2 inhibitors are available for prescribing to adults with type 2 diabetes.
Healthcare professionals (such as GPs, consultant diabetologists, advanced nurse practitioners, diabetes specialist nurses and pharmacists) offer adults with type 2 diabetes treatment with an SGLT-2 inhibitor after a discussion of the benefits and risks and taking into account individual circumstances.
Integrated care systems ensure that services can offer SGLT-2 inhibitors to adults with type 2 diabetes.
Adults with type 2 diabetes are offered an SGLT-2 inhibitor along with other medication to help reduce the risk of developing complications from their diabetes.
Source guidance
Type 2 diabetes in adults: management. NICE guideline NG28 (2015, updated 2026), recommendations 1.13.1, 1.13.2, 1.14.1, 1.14.2, 1.15.1, 1.15.2, 1.16.1, 1.16.2, 1.17.1, 1.17.2, 1.18.1, 1.18.2, 1.19.1, 1.19.2 and 1.20.2
Definitions of terms used in this quality statement
Prescribing an SGLT-2 inhibitor
Adults with type 2 diabetes should be offered a Sodium-Glucose Co-Transporter 2 inhibitor (SGLT-2 inhibitor) for treating type 2 diabetes, however individual circumstances should be considered, such as whether the person:
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has chronic kidney disease (and what their eGFR is)
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is pregnant or breastfeeding
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has any level of frailty, and whether that places them at risk of adverse events from SGLT-2 inhibitors (for example, volume depletion or hypotension).
Modifiable risk factors for diabetic ketoacidosis (DKA) should be addressed before starting an SGLT-2 inhibitor. Adults with type 2 diabetes who are taking an SGLT-2 inhibitor should be advised about minimising the risk of DKA when there is intercurrent illness and not to start a very low carbohydrate or ketogenic diet before speaking with their healthcare professional.
For a full list of contraindications and cautions see information from the Medicines and Healthcare products Regulatory Agency (MHRA), and in the BNF and summary of product characteristics (SPC) for SGLT-2 inhibitors. [Adapted from NICE's guideline on type 2 diabetes in adults, recommendations 1.18.1, 1.18.2, 1.19.1, 1.19.2, 1.21.1 to 1.21.3]