Electronic health records used to bridge gap on benefits of SGLT-2 inhibitors for type 2 diabetes
Diabetes drugs that may soon be prescribed more widely in England could save thousands of lives each year, suggests a new study led by researchers at the London School of Hygiene & Tropical Medicine (LSHTM) and UCL.
Last August the UK diabetes guideline committee at the National Institute for Health and Care Excellence (NICE) proposed SGLT-2 inhibitors alongside another drug, metformin, as a first-line treatment for people with type 2 diabetes. The final guidance is expected to be released on 18 February 2026.
Using anonymised health records from over 60,000 people, the new findings show that over a period of three years, a life was saved for every 47 people prescribed an SGLT-2 inhibitor. Given an estimated three million people receive treatment for type 2 diabetes in the UK, this suggests very broadly that about 20,000 deaths could be prevented each year.
SGLT-2 inhibitors, which lower blood sugar levels in the body, have been shown in clinical trials to have a protective effect on the kidneys and the heart, reducing the chance of premature deaths from cardiac events such as strokes and heart attacks.
However, these trials focused on carefully selected groups of people with type 2 diabetes who met strict criteria. This left a gap in knowledge about the effects of these drugs in broader, diverse populations typically living with the condition.
The new study, published in BMJ Open Diabetes Research & Care and funded by the National Institute for Health and Care Research (NIHR), used anonymised GP records to look at how effective an SGLT-2 inhibitor had been in reducing deaths among a much broader range of patients. The team used a "trial emulation" approach, which follows key principles of clinical trial design, such as carefully defining which patients to include and deciding in advance how to carry out the analysis, to avoid common biases that arise in the analysis of big data from GP records.
Records for over 60,000 people in the UK prescribed either empagliflozin (an SGLT-2 inhibitor) or an alternative blood sugar-lowering drug (a dipeptidyl peptidase-4 inhibitor) between 2014 and 2022 showed that people with type 2 diabetes who were prescribed the medicine were 24% less likely to have a premature death over an average of three years than those given another blood sugar-lowering drug.
Dr Patrick Bidulka, Assistant Professor at LSHTM and senior author, said: "This study is a good example of how patient data can help inform patient care. It shows how we can use electronic health records safely to complement evidence from randomised controlled trials to improve outcomes for patients."
At present, metformin alone is the standard first-line treatment for type 2 diabetes across the UK. SGLT-2 inhibitors are only recommended at this stage if there are additional risk factors such as established cardiovascular disease or chronic heart failure. This study was submitted to NICE as part of the consultation process around the updated guidelines.
Dr David Ryan, MD & PhD student at UCL and lead author 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."
This story is based on an original press release by UCL.
Publication
Ryan DK et al. Enhancing evidence-based care using trial emulation in electronic health records: real-world effects of empagliflozin in people with type 2 diabetes. BMJ Open Diabetes Research & Care. 2026. DOI: 10.1136/bmjdrc-2025-005672
