A new draft guideline on diabetes in adults is open for consultation until 14 October 2021

diabetes blood test

New draft guidelines from NICE recommend wider use of sodium–glucose co-transporter-2 inhibitors (SGLT2is) in the first-line treatment of diabetes in adults.

The draft guidance recommends that an SGLT2i should be added to metformin for the first-line treatment of diabetes in patients with congestive heart failure (CHF) or established atherosclerotic disease. The addition of an SGLT2i can also be considered for patients at high risk of developing cardiovascular disease (CVD).

When starting dual therapy with metformin and an SGLT2i as first-line therapy, it is recommended that the treatments be started sequentially, starting with metformin.

For people with CHF or established atherosclerotic CVD in whom metformin is contraindicated or not tolerated, SGLT2i monotherapy is recommended, and this can also be considered for people at high risk of developing CVD.

For patients who do not meet these criteria, first-line treatment with a dipeptidyl peptidase-4 inhibitor, pioglitazone, a sulfonylurea, or an SGLT2i can be considered if they meet the requirements set out in NICE guidance on canagliflozin, dapagliflozin, and empagliflozin as monotherapies for type 2 diabetes, and ertugliflozin as monotherapy or with metformin.

The new guidance cautions that SGLT2is should not be used in people who are following a very low carbohydrate or ketogenic diet, as this can lead to diabetic ketoacidosis.

For patients who are pregnant, planning a pregnancy, or breastfeeding, advice on contraception and family planning should be offered.

NICE also advises that renal function requires careful monitoring, as SGLT2is can cause fluid volume depletion and have an adverse effect on renal function.

The draft guidance is open for consultation until 14 October 2021. The final recommendations are expected to be published in February 2022.

This article originally appeared on Univadis, part of the Medscape Professional Network.