NICE recommends new triple therapy option for diabetes

Ertugliflozin (Steglatro) can now be prescribed routinely on the NHS in combination with metformin and a dipeptidyl peptidase 4 (DPP4) inhibitor for patients with type II diabetes.

SGLT2 inhibitors act in the proximal tubule of the kidney to inhibit reabsorption of glucose into the circulation.  | STEVE GSCHMEISSNER/SCIENCE PHOTO LIBRARY
SGLT2 inhibitors act in the proximal tubule of the kidney to inhibit reabsorption of glucose into the circulation. | STEVE GSCHMEISSNER/SCIENCE PHOTO LIBRARY

Ertugliflozin, as triple therapy with metformin and a DPP4 inhibitor, is recommended by NICE as an option for treating type II diabetes in adults when diet and exercise alone do not provide adequate glycaemic control, and:

  • control remains inadequate with metformin and a DPP4 inhibitor, or
  • a sulfonylurea or pioglitazone is not appropriate. 

Ertugliflozin is already approved by NICE as monotherapy or as dual therapy with metformin. 

The other SGLT2 inhibitors canagliflozin, dapagliflozin and empagliflozin are also approved by NICE for triple therapy, although they are recommended as options in combination with metformin and a sulfonylurea, or metformin and pioglitazone. Ertugliflozin has not been compared with a sulfonylurea or pioglitazone but it appears to have similar health benefits to other SGLT2 inhibitors when taken with metformin and a DPP4 inhibitor, and its acquisition cost is lower. 

The starting dose for ertugliflozin is 5mg once daily, which can be increased to 15mg once daily if necessary.

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