Ertugliflozin with metformin and a dipeptidyl peptidase‑4 (DPP‑4) inhibitor is recommended as an option for treating type 2 diabetes in adults when diet and exercise alone do not provide adequate glycaemic control, only if:
the disease is uncontrolled with metformin and a DPP‑4 inhibitor, and
a sulfonylurea or pioglitazone is not appropriate.
If patients and their clinicians consider ertugliflozin to be 1 of a range of suitable treatments, including canagliflozin, dapagliflozin and empagliflozin, the least expensive should be chosen.
These recommendations are not intended to affect treatment with ertugliflozin that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Why the committee made these recommendations
Ertugliflozin is a sodium-glucose cotransporter 2 (SGLT‑2) inhibitor. Other SGLT‑2 inhibitors are already used with metformin and a DPP‑4 inhibitor for treating type 2 diabetes. Ertugliflozin appears to have similar health benefits to other SGLT‑2 inhibitors when taken with metformin and a DPP‑4 inhibitor, and it has a lower acquisition cost. But it has only been compared with other SGLT‑2 inhibitors, not with other third-line treatments for type 2 diabetes (sulfonylureas or pioglitazone). Ertugliflozin is therefore recommended as an option for treating type 2 diabetes that is uncontrolled with metformin and a DPP‑4 inhibitor, only if a sulfonylurea or pioglitazone is not appropriate.