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The 2026 update from National Institute for Health and Care Excellence introduces a paradigm shift: From glucose-centric care to cardiorenalmetabolic protection New First-Line Strategy Most patients with type 2 diabetes should now receive: Modified-release metformin SGLT2 inhibitor (early combination therapy) Even without comorbidities If metformin is not tolerated: Use SGLT2 inhibitor monotherapy Why This Matters * SGLT2 inhibitors are no longer just glucose-lowering drugs: Reduce cardiovascular events Protect kidney function Improve long-term survival NICE estimates this strategy could prevent thousands of deaths Where Do DPP-4 Inhibitors Fit Now

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Three days after alloxan administration, animals were considered to be diabetic when after-fasting tail-vein blood glucose concentrations of 16 mmol/L, measured by an AccuChek Glucometer (Accu-Chek Active, Roche)

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