Wider use of SGLT-2 inhibitors in diabetes ‘could prevent 20,000 deaths a year’, say researchers

An upcoming recommendation by NICE to use SGLT-2 inhibitors more routinely in type 2 diabetes could save many thousands of lives a year, research has shown.

Draft guidance published by the National Institute of Health and Clinical Excellence (NICE) in August and due to be finalised this month recommended SGLT-2 inhibitors alongside metformin, as a first-line treatment for people with type 2 diabetes.

Where metformin is contraindicated or not tolerated, GPs should offer monotherapy with an SGLT-2 inhibitor, the committee said.

The decision, which represents a major ‘shake-up’ to current practice, was based on a ‘significant body of evidence’ that diabetes management should consider cardiovascular and renal protection not just HbA1c targets.

Now researchers from University College London have analysed GP records of 60,000 people in the UK and found that people with type 2 diabetes who were prescribed empagliflozin were 24% less likely to have a premature death over an average of three years than those given a dipeptidyl peptidase-4 inhibitor.

Writing in the journal BMJ Open Diabetes Research & Care, the researchers said the findings show the benefit of wider use of the drugs outside that seen in clinical trials of more high-risk groups.

Only one in five of this ‘real-world’ group of patients would have been eligible for clinical trials in which participants had established coronary artery disease.

Based on an estimate of three million people being treated for type 2 diabetes in the UK, researchers suggest about 20,000 deaths could be prevented each year.

Study lead Dr David Ryan, from the UCL Institute of Health Informatics, said: ‘Our study shows this drug works very well in a much wider range of people with type 2 diabetes than we previously had evidence for.

‘Our findings support NICE’s draft guidance proposing its use as a first treatment for type 2 diabetes, in addition to metformin – which would be a major shift in diabetes care affecting millions. The typical person with type 2 diabetes may live longer with these tablets.’

NICE analysis of the records of 590,000 people had shown that SGLT-2 inhibitors are under-prescribed, particularly to women, older people, and black patients.

Senior author Dr Anoop Shah, also based at UCL Institute of Health Informatics, said: ‘Clinical trials often recruit highly selected populations so their findings do not always generalise to the typical person living with type 2 diabetes.

‘Our real-world analysis fills an important evidence gap and supports broader use of SGLT-2 inhibitors in clinical practice.’