NICE GUIDELINES FOR DIABETES 2026
As of the major update on February 18, 2026, NICE (National Institute for Health and Care Excellence) has fundamentally shifted the management of Type 2 Diabetes from a glucose-centric model to a cardio-renal protection model.
As of the major update on February 18, 2026, NICE (National Institute for Health and Care Excellence) has fundamentally shifted the management of Type 2 Diabetes from a glucose-centric model to a cardio-renal protection model
The most significant change is the introduction of SGLT-2 inhibitors as a first-line treatment alongside Metformin for the majority of patients.
HbA1c Target
48 mmol/mol (6.5%) for those on lifestyle only or single drug (not associated with episodes of hypoglycemia).
53 mmol/mol (7.0%) for those on drugs with hypoglycemia risk (e.g., Sulfonylureas).
The 2026 update mandates a DUAL THERAPY start for most T2DM patients.
If the target is not reached with dual therapy add a 3rd Agent DPP-4 inhibitor (Gliptin), Pioglitazone, or a Sulfonylurea.
Early-Onset T2D (People age Under 40)
This patients are now recognized as a high-risk group. NICE recommends aggressive triple therapy ( Metformin + SGLT-2i + GLP-1/Tirzepatide) much earlier than in previous years.
Annual Review Checklist
Renal - Urine ACR and eGFR.
Eyes - Referral for digital retinal screening for Diabetic Retinopathy
Feet - Assessment of pulses and sensation (10g monofilament).
Cardiovascular RiskOptimize BP (<140/90 or <130/80 if complications) and start high-intensity statin ( like Atorvastatin 20mg) if QRISK >10%.
RSSDI and ESI Guidelines
Type 1 Diabetes Mandatory TSH and Anti-TPO screening at diagnosis (as high risk of Autoimmune Thyroid Disease).