NICE guidance - dapagliflozin in combination therapy for treating type 2 diabetes

Dapagliflozin is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor that blocks the reabsorption of glucose in the kidneys and promotes excretion of excess glucose in the urine. It has a UK marketing authorisation ’in adults aged 18 years and older with type 2 diabetes mellitus to improve glycaemic control.

SGLT-2 inhibitors, such as dapagliflozin, are indicated to be used in combination with modified-release metformin as initial drug therapy in most patients with Type 2 diabetes (1)

• in type 2 diabetes, an SGLT-2 inhibitor may be used as monotherapy if metformin inappropriate
• in chronic kidney disease and type 2 diabetes, the SGLT-2 inhibitor indicated varies with respect to estimated glomerular filtration rate (eGFR)
  • if eGFR >30 metformin + SGLT-2 inhibitor (any)
  • if eGFR 20–30: dapagliflozin or empagliflozin + dipeptidyl peptidase-4 (DPP-4 inhibitor)
  • if eGFR < 20 then NICE suggest consider a DPP-4 inhibitor
• in type 2 diabetes in the context of frailty then metformin is indicated as first-line therapy
  • ony add an SGLT-2 inhibitor if the person's level of frailty does not place them at risk of adverse events from such a medicine (for example, volume depletion or hypotension)

In type 2 diabetes, an SGLT-2 inhibitor may also be used in combination with insulin or other antidiabetic drugs.

Consult the summary of product characteristics before prescribing dapagliflozin.

Notes:

• summary of product characteristics lists the following adverse reactions for dapagliflozin: hypoglycaemia (when used with a sulfonylurea or insulin), urinary tract and genital infection, back pain, dysuria, polyuria, dyslipidaemia and elevated haematocrit
• the NICE committee noted that while the cardiovascular and renal protection provided by SGLT-2 inhibitors are retained at eGFR values below 45 ml/min/1.73 m², the glycaemic benefits may reduce
• SGLT-2 inhibitors and GLP-1 receptor agonists are recommended as much for their cardiovascular and renal benefits as for their glycaemic benefits

Reference:

1. NICE (February 2026). Type 2 diabetes in adults: management