Type 2 diabetes NG28: the February 2026 medicines pathways

Initial therapy follows the current clinical group

The summaries replace the previous cardiovascular-risk gate with the current pathways, including modified-release metformin with an SGLT2 inhibitor for adults without relevant comorbidities and alternatives when metformin is unsuitable.

Comorbidities change the treatment choice

Separate pathways now cover atherosclerotic cardiovascular disease, heart failure, early-onset diabetes, obesity, renal function and frailty, including the specific semaglutide recommendation for atherosclerotic cardiovascular disease.

Further medicines and review use the new recommendations

The summaries update the sequencing of additional medicines, the GLP-1 receptor agonist and tirzepatide pathways, the exclusion of DPP-4 inhibitor combinations with those treatments, and the current review and stopping rules.

Monitoring and insulin sit alongside medicine selection

The revised reading covers individualised HbA1c targets, insulin and glucose-monitoring decisions, kidney and blood-pressure assessment, eye screening and medicine-specific sick-day advice.

Primary sources

• NG28: initial medicines
• NG28: further medication
• NG28: reviewing medicines
• NG28: blood glucose management
• NG28: insulin-based treatments