EN
Home/United Kingdom/Blog/Ozempic for type 2 diabetes on the NHS: where does it fit now?
UKUnited Kingdom Diabetes

Ozempic for type 2 diabetes on the NHS: where does it fit now?

Ozempic, Mounjaro and other GLP-1 medicines in NICE's February 2026 diabetes guideline, with HbA1c results, side effects and prescription charges.

GLP Guidebook teamPublished 12 Oct 202610 min read21 sourcesWritten from published sources

Written for the UK. Reading from India? India version

The short answer

Ozempic (semaglutide) is licensed in the UK for type 2 diabetes only. NICE's February 2026 guideline starts most adults on metformin plus an SGLT-2 inhibitor, and offers Ozempic up to 1 mg to people with heart and artery disease. In its first trial, HbA1c fell 1.5 to 1.6 points.

Key takeaways

  • Ozempic is licensed in the UK for type 2 diabetes only, and the MHRA marks it as not licensed for weight loss.1,2
  • NICE's February 2026 guideline offers Ozempic up to 1 mg a week, with metformin and an SGLT‑2 inhibitor, to adults with type 2 diabetes and heart or artery disease.3
  • In the SUSTAIN 1 trial, HbA1c fell 1.5 to 1.6 points on Ozempic over 30 weeks against no change on a dummy; across the trials, 19.9% on 1 mg felt sick.2
  • In SUSTAIN 6, a heart attack, stroke or heart death happened to 6.6% on Ozempic and 8.9% on a dummy injection over 2 years.2
  • For diabetes, Ozempic usually costs nothing: England exempts diabetes treated with medicines from the £9.90 charge, and the other nations have free prescriptions.4,5,6
On this page
  1. Which GLP-1 medicines are licensed for type 2 diabetes in the UK?
  2. How does Ozempic lower blood sugar?
  3. Where does Ozempic sit in NICE's 2026 diabetes guideline?
  4. How much did HbA1c fall in the main trials?
  5. What do the heart and kidney trials show?
  6. Can it be taken with metformin, insulin or a sulfonylurea?
  7. What does Ozempic cost on the NHS?
  8. Questions people ask
  9. How we researched this

Which GLP-1 medicines are licensed for type 2 diabetes in the UK?

Ozempic, Rybelsus tablets, Mounjaro, Trulicity and generic liraglutide are among them. Ozempic and Rybelsus are licensed for diabetes only, not for weight loss.1,2

Before you go further
  • GLP‑1 medicines are prescription-only in the UK. On the NHS or privately, a healthcare professional has to assess you before a prescription is issued.1
  • The label facts here come from the UK product information (the SmPC, the official label each maker publishes on the electronic Medicines Compendium). Where we use a US or EU label instead, we say so.
  • This post reports UK labels, NICE guidance and trials. It is not a plan for starting or changing your diabetes medicines.
  • Every risk of these medicines is in Guide 5: Side effects and risks.
  • This post describes labels, guidance and trials. It is not a plan for your treatment, and no dose or brand guarantees any result.

Ozempic is semaglutide, a weekly injection. The UK label licenses it for adults with type 2 diabetes that diet and exercise have not controlled, alone or with other diabetes medicines.2 The MHRA's own table marks Ozempic and Rybelsus "No" for weight loss and Wegovy "No" for diabetes.1

  • Semaglutide: Ozempic weekly pens, 0.25 mg up to 2 mg, and Rybelsus daily tablets, both for diabetes.1,2
  • Tirzepatide: Mounjaro is licensed both for type 2 diabetes, from age 10, and for weight management.7
  • Liraglutide: a daily injection. Generic diabetes pens are listed on the UK medicines database; we found no Victoza listing there in October 2026.8 More in generic liraglutide vs Saxenda.

Type 2 diabetes is when the hormone insulin doesn't work properly, or there isn't enough of it, so blood sugar runs too high.9 HbA1c is a blood test of your average blood sugar over the last 2 to 3 months.10 NICE's usual targets are 48 mmol/mol (6.5%), or 53 mmol/mol (7.0%) for people on a medicine that can cause hypos.3

How does Ozempic lower blood sugar?

It makes the pancreas release more insulin and less glucagon, mainly when blood sugar is high. It also slows the stomach a little after meals.2

Insulin moves sugar out of the blood. Glucagon tells the liver to release sugar. The UK label says semaglutide lowers blood sugar "in a glucose dependent manner", and that during a hypo it reduces insulin release.2

The UK label starts at 0.25 mg a week for 4 weeks, then 0.5 mg. It goes to 1 mg, then 2 mg, only if more sugar control is needed, after at least 4 weeks on each.2 The 0.25 mg dose is a starting dose, not a treatment dose.2

Where does Ozempic sit in NICE's 2026 diabetes guideline?

NICE now starts most adults on metformin plus an SGLT‑2 inhibitor tablet. It puts Ozempic up to 1 mg first in line for people with heart and artery disease.3

NICE updated its type 2 diabetes guideline (NG28) on 18 February 2026.3 SGLT‑2 inhibitors are tablets such as dapagliflozin and empagliflozin. Here is where GLP‑1 medicines now sit:3

  • Heart and artery disease (atherosclerotic cardiovascular disease), such as a past heart attack, stroke or narrowed leg arteries. NICE says offer Ozempic up to 1 mg a week, with metformin and an SGLT‑2 inhibitor.3
  • Developing that disease later: offer to add Ozempic up to 1 mg.3
  • Diabetes diagnosed before 40 (early onset): consider adding a GLP‑1 medicine or tirzepatide.3
  • Living with obesity: consider adding a GLP‑1 medicine or tirzepatide after at least 3 months of first treatment, if more is needed to reach your sugar target.3

NICE says its GLP‑1 recommendations cover liraglutide, dulaglutide and semaglutide, and for Ozempic only doses up to 1 mg.3 It says to stop a GLP‑1 or tirzepatide if you become underweight, or if it isn't helping you reach your sugar target and isn't being taken for the heart.3

How much did HbA1c fall in the main trials?

In Ozempic's first placebo trial, HbA1c fell 1.5 to 1.6 points over 30 weeks, against no change on a dummy injection. Across the trials, about 1 in 5 on 1 mg felt sick.2

In SUSTAIN 1, 388 people whose diabetes diet and exercise had not controlled took Ozempic 0.5 mg, 1 mg, or a dummy injection (placebo). Average HbA1c started at about 8.1% (65 mmol/mol, by the standard conversion).2

SUSTAIN 1Ozempic 0.5 mg and 1 mg vs dummy injection

388 adults with type 2 diabetes on diet and exercise alone, 30 weeks, UK label figures.2

Reached HbA1c below 7% (53 mmol/mol)

0.5 mg74%
1 mg72%
Dummy injection25%

Weight fell 3.7 kg and 4.5 kg on Ozempic, against 1.0 kg on the dummy.

Side effects across the trials. The UK label says 17% on 0.5 mg and 19.9% on 1 mg felt sick. Diarrhoea affected 12.2% and 13.3%, and vomiting 6.4% and 8.4%.2 Stomach effects led 3.9% and 5% to stop, mostly in the first months.2

Head to head. SURPASS‑2 compared Mounjaro with Ozempic 1 mg in 1,879 people on metformin for 40 weeks. HbA1c fell 1.86 points on Ozempic and 2.01 to 2.30 on Mounjaro. Nausea was similar, 18% against 17% to 22%.11 Everyone knew which medicine they had, and Eli Lilly paid for it.11

RisksThe risks, in brief
  • Stomach effects. Feeling sick and diarrhoea are very common on the UK Ozempic label (more than 1 in 10).2
  • Hypos with insulin or a sulfonylurea are very common (more than 1 in 10); with other diabetes tablets they are common.2
  • Pancreatitis is uncommon (1 in 100 to 1 in 1,000) on the UK Ozempic label.2
  • Gallstones are common (1 in 10 to 1 in 100).2
  • Eyes. In a 2-year trial, diabetic eye complications were more common on semaglutide: 3 in 100 against 1.8 in 100 on a dummy, in insulin users with known eye disease.2
  • Sudden loss of sight (NAION) is very rare; the MHRA says to go to eye casualty or A&E urgently.12
Full detail in Guide 5: Side effects and risks →

What do the heart and kidney trials show?

Ozempic lowered heart events in one trial and serious kidney events in another. Mounjaro was no worse for the heart than another GLP‑1, Trulicity, but not shown better.2,13,14

  • Heart (SUSTAIN 6). 3,297 people with type 2 diabetes at high heart risk took Ozempic or a dummy for 2 years. A heart attack, stroke or heart death happened to 6.6% on Ozempic and 8.9% on the dummy.2 Novo Nordisk paid for it.15
  • Kidneys (FLOW). 3,533 people with diabetes and kidney disease took Ozempic 1 mg or a dummy for about 3.4 years. Kidney failure, a big fall in kidney function, or kidney or heart death happened to 18.7% on Ozempic against 23.2% on the dummy.13 Novo Nordisk paid for it.13
  • Mounjaro (SURPASS‑CVOT). 13,299 people with diabetes and heart disease took Mounjaro or Trulicity for about 4 years. Heart events happened to 12.2% on Mounjaro against 13.1% on Trulicity, too small a gap to call Mounjaro better. Eli Lilly paid for it.14

NICE offers Ozempic up to 1 mg to people with heart and artery disease "for its cardiovascular, renal and glycaemic benefits".3

Free toolQuestions for your diabetes review

Answer a few questions and get a printable sheet for your GP or diabetes nurse, including the medicines you take now. No sign-up.

Make my list

Can it be taken with metformin, insulin or a sulfonylurea?

Yes, and NICE expects it alongside metformin and an SGLT‑2 inhibitor. With insulin or a sulfonylurea, hypos become very common, so those doses may be lowered.2,3

  • Metformin and SGLT‑2 inhibitors. NICE introduces medicines one at a time: metformin first, then the SGLT‑2 inhibitor, then the GLP‑1 once that is at its top tolerated dose.3
  • Insulin or a sulfonylurea (such as gliclazide). The UK label says to consider lowering their dose when Ozempic starts, to reduce hypos.2 It recommends cutting insulin in steps.2
  • DPP‑4 inhibitors ("gliptins" such as sitagliptin). NICE says not to offer one together with a GLP‑1 medicine or tirzepatide.3
Get help now: call 999 for a life-threatening emergency.16 Call if someone with a low becomes unconscious or isn’t responding normally, or for severe stomach pain that won’t go away, a possible sign of pancreatitis.2 For urgent advice that is not an emergency, use NHS 111 in England, Scotland and Wales, online or by phone.17 Northern Ireland has no 111 service: call your GP practice or the GP out-of-hours service.18

What does Ozempic cost on the NHS?

Usually nothing for diabetes. In England a medical exemption covers diabetes treated with medicines, and prescriptions are free in Scotland, Wales and Northern Ireland.4,6,19,20

  • England: the charge is £9.90 per item.5 A medical exemption certificate covers "diabetes mellitus, except where treatment is by diet alone".4
  • Scotland: prescription charges were abolished from 1 April 2011.6
  • Wales: people registered with a Welsh GP get free prescriptions from a pharmacist in Wales.19
  • Northern Ireland: all prescriptions dispensed there are free for everyone.20

The shortage is over. Diabetes UK says shortages of GLP‑1 medicines were reported resolved at the end of January 2025. It says they should still be prescribed only for their licensed uses.21 That is one reason Ozempic is not used for weight loss on the NHS. See Can I get Ozempic for weight loss in the UK?

The cost calculator works out charges over 6 and 12 months. NHS charges for weight-loss use are in how much Mounjaro and Wegovy cost in the UK.

Questions people ask

Can my GP prescribe Ozempic for type 2 diabetes?

NICE's 2026 guideline expects GLP‑1 medicines to be offered or considered in set situations, such as heart and artery disease or obesity.3 Whether it suits you is your prescriber's decision.

Is Ozempic free on the NHS for diabetes?

Usually. In England a medical exemption certificate covers diabetes treated with medicines, and Scotland, Wales and Northern Ireland have free prescriptions.4,6,19,20

Is Mounjaro better than Ozempic for diabetes?

In SURPASS‑2, HbA1c fell 1.86 points on Ozempic 1 mg and 2.01 to 2.30 on Mounjaro, with similar nausea. Eli Lilly, which makes Mounjaro, paid for the trial.11

Can I take Ozempic with metformin?

Yes. NICE adds GLP‑1 medicines on top of metformin and an SGLT‑2 inhibitor, one at a time.3

Does Ozempic cause hypos?

On its own the risk is low. The UK label rates hypos as very common with insulin or a sulfonylurea, and common with other diabetes tablets.2

Shorter answers: Can I get Ozempic for weight loss in the UK?

How we researched this

On 12 Oct 2026 we read the UK Ozempic and Mounjaro labels and NICE NG28 as updated on 18 February 2026. We also read the MHRA’s patient guidance and the prescription-charge pages for all four nations. SUSTAIN 1 and SUSTAIN 6 figures come from the UK Ozempic label; SURPASS‑2, FLOW and SURPASS‑CVOT from the published papers.

We could not open an official NHS list price for Ozempic, because the BNF is blocked from our location. So we give the charge patients pay, not the NHS price. The heart and kidney trials were paid for by the makers.

Before you move on

  • Ozempic is licensed in the UK for type 2 diabetes only.
  • NICE 2026 starts with metformin and an SGLT‑2 tablet, and offers Ozempic up to 1 mg for heart and artery disease.
  • In trials, HbA1c fell about 1.5 points, and 1 in 5 on 1 mg felt sick.
  • With insulin or a sulfonylurea, hypos become more likely.
Side effects and risksThe medicines in the UKCost calculator

More from the UK blog

UKUnited KingdomWegovy vs Mounjaro in the UK UKUnited KingdomGeneric liraglutide vs Saxenda in the UK UKUnited KingdomPancreatitis and gallbladder: the MHRA warning
About GLP Guidebook

The monthly UK update

An independent guide to GLP‑1 medicines. We don't sell medicines, take drug-company money or earn clinic commissions. Once a month: NHS access changes, approvals, safety notices and recalls. How we write

Was this post easy to understand?

Sources

  1. MHRA (Medicines and Healthcare products Regulatory Agency). GLP‑1 medicines for weight loss and diabetes: what you need to know. First published 5 June 2025, updated 5 February 2026. gov.uk
  2. Novo Nordisk. Ozempic (semaglutide) pens: UK SmPC, date of revision 07/2026. Sections 4.1, 4.2, 4.4, 4.6, 4.8, 5.1, 5.2. emc
  3. NICE. Type 2 diabetes in adults: management (NG28). Published 2 December 2015, last updated 18 February 2026. Recommendations 1.5.7, 1.13 to 1.29 and 1.20. Blood glucose management · How to introduce medicines · Initial medicines · Further medication · Reviewing medicines · Terms
  4. NHS Business Services Authority. Medical exemption certificates (England): includes “diabetes mellitus, except where treatment is by diet alone”. Opened 12 October 2026. nhsbsa.nhs.uk
  5. NHS Business Services Authority. NHS prescription prepayment certificate (PPC): England prescription charge £9.90 per item. Opened 12 October 2026. nhsbsa.nhs.uk
  6. Scottish Government. Help with health costs (HCS2): quick guide, August 2021: “From 1 April 2011 prescription charges have been abolished in Scotland”. gov.scot
  7. Eli Lilly. Mounjaro KwikPen (tirzepatide): UK summary of product characteristics (SmPC, the UK label), date of revision 29 August 2026. Sections 4.2, 4.4, 4.5, 4.6, 4.8, 5.2, 6.4. emc
  8. Electronic Medicines Compendium (emc). Search for “liraglutide”, 12 October 2026: generic liraglutide pens for type 2 diabetes (Liraglutide Biocon, Diavic, Zegluxen) and for weight; no Victoza listing returned. emc search
  9. NHS. Type 2 diabetes. Opened 12 October 2026. nhs.uk
  10. Diabetes UK. What is HbA1c? Opened 12 October 2026. diabetes.org.uk
  11. Frías JP et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes (SURPASS-2). N Engl J Med 2021;385:503–15. 1,879 people, all on metformin, 40 weeks, open-label. Funded by Eli Lilly. DOI · PMID 34170647
  12. MHRA. Drug Safety Update: Semaglutide (Wegovy, Ozempic and Rybelsus): risk of non-arteritic anterior ischemic optic neuropathy (NAION). 5 February 2026. gov.uk
  13. Perkovic V et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes (FLOW). N Engl J Med 2024;391:109–21. 3,533 people, median 3.4 years; percentages worked out from 331 of 1,767 and 410 of 1,766. Funded by Novo Nordisk. DOI · PMID 38785209
  14. Nicholls SJ et al. Tirzepatide or dulaglutide for cardiovascular outcomes in type 2 diabetes (SURPASS-CVOT). N Engl J Med 2025;393(24):2409–20. 13,299 people. Funded by Eli Lilly. DOI · PMID 41406444
  15. Marso SP et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes (SUSTAIN-6). N Engl J Med 2016;375:1834–44. 3,297 people, 104 weeks. Funded by Novo Nordisk. DOI · PMID 27633186
  16. NHS. When to call 999. Page last reviewed 3 February 2023. nhs.uk
  17. NHS. When to use NHS 111 online or call 111. Opened 12 October 2026. nhs.uk
  18. nidirect (Northern Ireland government). GP out of hours service. Opened 12 October 2026. nidirect.gov.uk
  19. Welsh Government. Free prescriptions. Opened 12 October 2026. gov.wales
  20. nidirect. Help with health costs: “All prescriptions dispensed in Northern Ireland are free of charge for everyone”. Opened 12 October 2026. nidirect.gov.uk
  21. Diabetes UK. Our response to serious supply issues of drugs for people living with type 2 diabetes. Update of 20 October 2025. diabetes.org.uk

Last checked 12 Oct 2026 · Next review due 12 Apr 2027 · Report an error

How this post was made. Written by the GLP Guidebook team from the sources above. It's general information, not medical advice. Talk to a qualified doctor, nurse or pharmacist before starting, stopping or changing any medicine. How we write