Fig. 1
SGLT2-inhibitor recommendations for type 2 diabetes currently treated with anti-hyperglycaemic medication in UK primary care. Estimates are derived from a UK cohort of people with type 2 diabetes (Clinical Practice Research Datalink, n = 568,524 actively registered with a GP practice in February 2020). People with chronic kidney disease stage 4–5 were excluded (n = 18,594) as this group represents a specific population with different criteria for SGLT2-inhibitor initiation. Remaining individuals were classified as either currently receiving anti-hyperglycaemic treatment (73.0%, n = 415,267) or currently untreated (27.0%, n = 153,257). NICE criteria was then used to classify individuals by cardiovascular disease status as (1) having established atherosclerotic cardiovascular disease or heart failure [Offer SGLT2-inhibitor]; (2) at high-risk of cardiovascular disease as defined by a 10-year risk of cardiovascular disease > 10% applying the QRISK2 algorithm [Consider SGLT2-inhibitor]; (3) not at high-risk of cardiovascular disease (QRISK2 < 10%) [SGLT2-inhibitor not indicated]. Amongst the 27.0% currently untreated individuals, the majority of whom will eventually require treatment, 93.3% are recommended or considered for SGLT2-inhibitor therapy, with the majority (57.6%) eligible on the basis of QRISK2 rather than established ASCVD (35.7%) [data not shown]