1.1 Ertugliflozin as monotherapy is recommended as an option for treating type 2 diabetes in adults for whom metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control, only if:
a dipeptidyl peptidase 4 (DPP‑4) inhibitor would otherwise be prescribed and
a sulfonylurea or pioglitazone is not appropriate.
1.2 Ertugliflozin in a dual-therapy regimen in combination with metformin is recommended as an option for treating type 2 diabetes, only if:
a sulfonylurea is contraindicated or not tolerated or
the person is at significant risk of hypoglycaemia or its consequences.
1.3 If patients and their clinicians consider ertugliflozin to be 1 of a range of suitable treatments including canagliflozin, dapagliflozin and empagliflozin, the least expensive should be chosen.
1.4 These recommendations are not intended to affect treatment with ertugliflozin that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Why the committee made these recommendations
Canagliflozin, dapagliflozin and empagliflozin are options for treating type 2 diabetes in adults. They are taken with metformin or on their own (that is, as monotherapy) if metformin is not appropriate. They are sodium-glucose cotransporter 2 (SGLT‑2) inhibitors, as is ertugliflozin.
Indirect comparisons show that ertugliflozin has similar overall health benefits to canagliflozin, dapagliflozin and empagliflozin. The acquisition cost of ertugliflozin is lower than the acquisition costs of these other drugs. Ertugliflozin is therefore recommended as an option for treating type 2 diabetes as monotherapy or with metformin in line with the previous recommendations for SGLT‑2 inhibitors.