GLP-1 Treatments
Updated April 2026

GLP-1 for Type 2 Diabetes
in the UK

A comprehensive guide to how GLP-1 receptor agonists fit into NHS diabetes care: NICE prescribing guidelines, combination therapy, HbA1c targets and the key differences from weight loss use.

Key facts

  • NICE guideline: NG28 recommends GLP-1 RAs as third-line therapy when dual oral treatment fails to achieve HbA1c targets
  • NHS availability: Ozempic, Trulicity (dulaglutide), Victoza (liraglutide) and Mounjaro (tirzepatide) are all available on the NHS for type 2 diabetes
  • HbA1c reduction: Typically 10–18 mmol/mol (1.0–1.8 percentage points) depending on agent and dose
  • Weight benefit: Most patients also lose 3–7 kg, which further improves metabolic health
  • Low hypoglycaemia risk: GLP-1 RAs rarely cause hypos when used without sulphonylureas or insulin

What are GLP-1 receptor agonists?

GLP-1 receptor agonists (GLP-1 RAs) are injectable medications that mimic the action of glucagon-like peptide-1, a natural gut hormone released after eating. They stimulate insulin secretion when blood glucose is elevated, suppress glucagon release, slow gastric emptying and promote satiety. For people with type 2 diabetes, this translates into lower blood sugar levels, reduced appetite and meaningful weight loss.

Unlike older diabetes medications such as sulphonylureas, GLP-1 RAs work in a glucose-dependent manner. This means they are far less likely to cause hypoglycaemia when used on their own or combined with metformin. The science behind how these medications work is explored in detail in our semaglutide mechanism guide.

The NICE NG28 prescribing ladder

NICE guideline NG28 (Type 2 diabetes in adults: management) sets out a step-by-step approach to blood glucose control. Understanding where GLP-1 RAs sit in this ladder helps you have informed conversations with your GP or diabetes nurse.

Step 1 — Lifestyle and metformin

The first-line treatment for virtually all adults newly diagnosed with type 2 diabetes is metformin, alongside dietary changes and increased physical activity. Metformin reduces hepatic glucose output and improves insulin sensitivity. If HbA1c remains above the agreed target (usually 48 mmol/mol for monotherapy, 53 mmol/mol for dual therapy) after three to six months, the next step is considered.

Step 2 — Dual therapy

A second oral agent is added to metformin. Options include a sulphonylurea, a DPP-4 inhibitor (gliptin), pioglitazone or an SGLT2 inhibitor (such as dapagliflozin or empagliflozin). The choice depends on individual factors: cardiovascular risk, kidney function, weight concerns and risk of hypoglycaemia. SGLT2 inhibitors are increasingly favoured in patients with established cardiovascular disease or chronic kidney disease.

Step 3 — Triple therapy or GLP-1 RA

If HbA1c targets are still not met on dual therapy, NICE recommends considering either triple oral therapy or a GLP-1 receptor agonist. A GLP-1 RA is particularly recommended when:

NICE continuation rule: Treatment with a GLP-1 RA should be reviewed after six months. It is continued only if there has been a beneficial metabolic response — defined as a reduction in HbA1c of at least 11 mmol/mol (1 percentage point) and a weight loss of at least 3% of body weight.

Step 4 — Insulin or further intensification

If a GLP-1 RA does not achieve adequate control, or if it is not suitable, the next step is usually basal insulin. Importantly, some patients may use a GLP-1 RA alongside basal insulin. Fixed-ratio combinations such as iDegLira (Xultophy) or iGlarLixi (Suliqua) combine a basal insulin with a GLP-1 RA in a single pen, simplifying the regimen.

GLP-1 medications available on the NHS for diabetes

Medication Active ingredient Frequency Typical HbA1c reduction
Ozempic Semaglutide Once weekly 12–18 mmol/mol
Trulicity Dulaglutide Once weekly 10–15 mmol/mol
Victoza Liraglutide Once daily 10–14 mmol/mol
Mounjaro Tirzepatide Once weekly 14–22 mmol/mol
Byetta / Bydureon Exenatide Twice daily / once weekly 8–12 mmol/mol

Tirzepatide (Mounjaro) is a dual GIP/GLP-1 receptor agonist. NICE approved it for type 2 diabetes in 2023 (TA924). It is now available through some GPs and community diabetes services. See our Mounjaro NHS guide for eligibility details.

Combination with metformin: why it works

Metformin and GLP-1 RAs target different pathways. Metformin primarily reduces glucose production by the liver and modestly improves peripheral insulin sensitivity. GLP-1 RAs enhance glucose-dependent insulin secretion, suppress glucagon, slow gastric emptying and reduce appetite. Together, they address multiple defects of type 2 diabetes without increasing hypoglycaemia risk.

The SUSTAIN and PIONEER trial programmes for semaglutide, and the SURPASS programme for tirzepatide, enrolled patients already on metformin. Results consistently showed that adding a GLP-1 RA to metformin produced superior HbA1c reductions compared with adding a sulphonylurea, DPP-4 inhibitor or even basal insulin, with the added benefit of weight loss rather than weight gain.

Practical points for combination therapy

HbA1c targets and monitoring

NICE NG28 does not set a single HbA1c target for all patients. Instead, it recommends personalised targets agreed between the patient and their clinical team. As a general guide:

HbA1c should be checked every three to six months while treatment is being adjusted, and at least every six months once stable. Annual diabetes reviews also assess blood pressure, cholesterol, kidney function (eGFR and urine albumin-to-creatinine ratio), retinal screening and foot checks.

Diabetes use vs weight loss use: key differences

One source of confusion is that the same active ingredient — semaglutide — is prescribed under different brand names for different indications. Understanding the distinction is important.

Feature Diabetes (e.g. Ozempic) Weight loss (e.g. Wegovy)
Licensed indication Type 2 diabetes mellitus Chronic weight management (BMI ≥ 30, or ≥ 27 with comorbidity)
Maximum dose Semaglutide 2 mg weekly Semaglutide 2.4 mg weekly
Primary outcome HbA1c reduction Percentage body weight loss
NHS prescriber GP or diabetes specialist Specialist weight management service
Supply protection Ozempic reserved for diabetes Wegovy for weight management only
Continuation criteria HbA1c reduction ≥ 11 mmol/mol + 3% weight loss ≥ 5% weight loss at 6 months

Important: The NHS has placed restrictions on prescribing Ozempic for weight loss to protect supply for diabetes patients. If your primary goal is weight management rather than blood sugar control, your clinician should consider Wegovy or Mounjaro through the appropriate pathway. Read more in our prescription guide.

Cardiovascular and renal benefits

Beyond blood sugar and weight, several GLP-1 RAs have demonstrated cardiovascular benefits in large outcome trials. The SUSTAIN-6 trial showed that semaglutide reduced major adverse cardiovascular events (MACE) by 26% in patients with type 2 diabetes and established cardiovascular disease. The SELECT trial further demonstrated cardiovascular risk reduction in patients with obesity regardless of diabetes status.

In April 2026, NICE approved Wegovy specifically for cardiovascular risk reduction, potentially benefiting 1.2 million additional patients. For diabetes patients with cardiovascular disease, this adds another layer of benefit to GLP-1 RA therapy.

Emerging evidence also suggests renoprotective effects, with ongoing trials (FLOW) investigating semaglutide in diabetic kidney disease. SGLT2 inhibitors remain the first choice for renal protection in diabetes, but GLP-1 RAs may offer additive benefits.

Side effects in the diabetes context

The side effect profile of GLP-1 RAs in diabetes is similar to that in weight management. The most common adverse effects are gastrointestinal: nausea, vomiting, diarrhoea and constipation. These are typically mild to moderate and improve over time, particularly with slow dose escalation.

Key considerations for diabetes patients specifically:

For a full breakdown of adverse effects, read our detailed Ozempic side effects guide and general GLP-1 side effects guide.

Practical tips for patients starting GLP-1 therapy for diabetes

  1. Expect a slow start: Your dose will be escalated gradually over several weeks to minimise nausea. Do not rush the titration.
  2. Keep a food diary: Track meals and blood glucose readings during the first few months. This helps your diabetes team optimise your treatment. See our diet guide for meal planning advice.
  3. Monitor blood glucose more closely if you also take a sulphonylurea or insulin. Your diabetes team may reduce those doses pre-emptively.
  4. Stay hydrated: Nausea and reduced appetite can lead to lower fluid intake. Aim for 6–8 glasses of water daily.
  5. Attend all review appointments: The six-month continuation review is critical. Bring your blood glucose diary and any concerns about side effects.
  6. Report side effects: Use the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk) to report any suspected adverse reactions.
  7. Combine with exercise: Even moderate physical activity enhances insulin sensitivity and helps preserve muscle mass during weight loss.

When GLP-1 therapy may not be suitable

GLP-1 RAs are not appropriate for everyone with type 2 diabetes. Contraindications and cautions include:

Frequently asked questions

Can I get a GLP-1 injection on the NHS for type 2 diabetes?

Yes. NICE guideline NG28 recommends GLP-1 receptor agonists as a third-line option for adults with type 2 diabetes whose HbA1c remains above target despite dual oral therapy. Your GP or diabetes specialist can prescribe semaglutide (Ozempic), dulaglutide (Trulicity) or liraglutide (Victoza) on the NHS if you meet the criteria.

What is the difference between Ozempic for diabetes and Wegovy for weight loss?

Both contain semaglutide, but Ozempic is licensed for type 2 diabetes at doses up to 2 mg weekly, with the primary goal of lowering HbA1c. Wegovy is licensed for weight management at a higher dose of 2.4 mg weekly, and its primary endpoint is percentage body weight loss. The NHS restricts Ozempic to diabetes patients to protect supply.

How much does HbA1c drop on GLP-1 medication?

Clinical trials typically show an HbA1c reduction of 10 to 18 mmol/mol (roughly 1.0 to 1.8 percentage points) depending on the specific GLP-1 RA and dose. Tirzepatide (Mounjaro) has demonstrated reductions of up to 22 mmol/mol in the SURPASS trials. Individual results vary based on baseline HbA1c, diet, exercise and concurrent medications.

Can I take a GLP-1 injection alongside metformin?

Yes. In fact, NICE NG28 recommends continuing metformin when adding a GLP-1 receptor agonist. The combination provides complementary blood sugar control without increased hypoglycaemia risk. There is no need to adjust your metformin dose.

Will I lose weight if I am prescribed a GLP-1 for diabetes?

Weight loss is a common beneficial effect. Most patients lose between 3 and 7 kg over 6 to 12 months, though individual results vary. If significant weight management is your primary goal, your clinician may consider a dedicated weight management pathway. Learn more about what happens when you stop treatment.

Related guides

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