Type 2 diabetes mellitus is a long-term condition in which the body becomes resistant to insulin or produces too little of it, leading to raised blood glucose. It accounts for around nine in 10 people with diabetes in England, where the National Diabetes Audit recorded more than 3.7 million people with type 2 diabetes in 2024/25.
Most type 2 diabetes care takes place in general practice, supported by community and specialist diabetes teams. NHS England estimates that the NHS spends around £10.7bn a year identifying and treating diabetes, and the cost of diabetes medicines prescribed in England reached £1.92bn in 2024/25, double the figure for 2015/16.
The National Diabetes Audit tracks eight annual care processes and three treatment targets (HbA1c, blood pressure and statin prescribing). In 2024/25, 58.2% of people with type 2 diabetes received all eight care processes, with Integrated Care Boards ranging from 38.6% to 73.5%, and 45.2% met all three treatment targets.
NICE updated its guideline NG28 on 18 February 2026. It now recommends modified-release metformin with an SGLT-2 inhibitor as first-line treatment for adults with type 2 diabetes, with further additions for people with cardiovascular disease, heart failure or early-onset type 2 diabetes. The overlap with obesity care is growing: NHS England began a phased rollout of tirzepatide for obesity in primary care in June 2025, with type 2 diabetes among the qualifying conditions.
The NG28 update changes prescribing at the first step of treatment, so ICB formularies, local pathways and practice systems need to change with it. Wide variation in care processes between ICBs shows where support for diagnosis, monitoring and treatment optimisation in primary care can have most effect.
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