I have type 2 diabetes. Are GLP-1 medicines for me?

Where do GLP-1s fit in NHS diabetes care?

Usually as an add-on, not the first medicine. NICE, the body that writes guidance for the NHS in England, updated its type 2 diabetes guideline in February 2026.¹

Under that guideline, most adults now start on two tablets: metformin, plus an SGLT-2 inhibitor (a tablet that makes the kidneys pass more sugar out in urine).¹ A GLP-1 medicine comes in on top of that in three situations:¹

• Heart or blood-vessel disease. If you develop disease caused by narrowed arteries (atherosclerotic cardiovascular disease, such as a heart attack or stroke), NICE says to offer semaglutide (Ozempic) injections, up to 1 mg a week.¹
• Living with obesity. NICE says to consider adding a GLP-1 medicine or tirzepatide (Mounjaro) after at least 3 months on your first medicines, if you need more treatment.¹
• Diabetes that started young. For early-onset type 2 diabetes, NICE says to consider adding a GLP-1 medicine or tirzepatide.¹

Your GP or diabetes team prescribes them. What you pay:

• England. If your diabetes is treated with medicines (not diet alone), you can get a medical exemption certificate, which makes your NHS prescriptions free.³
• Scotland, Wales and Northern Ireland. NHS prescriptions are free for everyone (in Wales, if you're registered with a Welsh GP).^4,5,6

What is HbA1c, and how often is it tested?

HbA1c is a common blood test that shows your average blood sugar over the last 2 to 3 months. It's the main number used to track type 2 diabetes.

Sugar in your blood sticks to haemoglobin, the protein in red blood cells. The test measures how much of it has sugar attached. The more sugar in your blood over those months, the higher the number.¹⁸ A finger-prick test shows your sugar at one moment. HbA1c is closer to an average over months.²

• The UK unit. UK results are usually given in mmol/mol. Many websites use a percentage instead. For example, 48 mmol/mol is the same as 6.5%, and 53 mmol/mol is the same as 7.0%.¹
• No fasting needed. It's a normal blood draw, at any time of day.¹⁷
• How often. NICE says every 3 to 6 months until your HbA1c is stable on unchanging treatment, then every 6 months.¹
• The diabetes range. An HbA1c of 6.5% (48 mmol/mol) or above is in the diabetes range.¹⁷

What HbA1c should I aim for?

NICE's usual target is 48 mmol/mol (6.5%), or 53 mmol/mol (7.0%) if you take a medicine that can cause low sugar. You and your doctor agree yours.

A lower target means less risk of long-term damage, but more risk of low sugar. That's why it differs from person to person.^1,2

What two guidelines say:

NICE is the National Institute for Health and Care Excellence.

How do they compare with metformin, and can I take both?

Metformin is a common first tablet for type 2 diabetes. In a direct comparison, a weekly GLP-1 lowered HbA1c a little more than metformin. The two can also be taken together.

A fall in HbA1c of 1 point means, for example, going from 8% to 7%. The two trials below compared medicines with each other, not with a dummy treatment.

Average fall in HbA1c, in percentage points:

These are averages from two separate trials with different people, so don't compare numbers across the two cards. The Ozempic label reports no new safety problems in 959 people who took it with metformin in trials.¹²

What if I also take insulin or a sulfonylurea?

Then your risk of low sugar (a hypo) goes up. Your doctor may lower your insulin or sulfonylurea dose when you start.

Sulfonylureas are older tablets such as gliclazide and glimepiride. They can cause hypos on their own.¹ The Ozempic label warns that combining them can cause hypos, including severe ones.¹² A lower sulfonylurea or insulin dose may reduce that risk.¹² That's your doctor's call, so don't change doses yourself.

Signs of low sugar include:¹²

• dizziness, shaking or sweating
• hunger
• blurred vision
• a fast heartbeat
• confusion or drowsiness

What about my kidneys and eyes?

For kidneys, one large trial found fewer serious kidney problems on semaglutide in people who already had kidney disease. For eyes, tell whoever checks your eyes that you've started, especially if you have retinopathy (damage to the back of the eye from diabetes).

A large kidney trial followed 3,533 people who had type 2 diabetes and kidney disease, for about 3.4 years. Half took semaglutide (Ozempic) 1 mg a week, half a dummy injection with no medicine in it.¹³

The researchers counted everyone who had any one of these:¹³

• kidney failure: needing dialysis or a transplant, or kidney function falling very low
• losing at least half of their kidney function
• dying from kidney or heart causes

Out of every 100 people, how many had one or more of these:

What this means. Semaglutide lowered the risk of these events by about a quarter (24%).¹³ Put simply: for every 22 people treated for about 3 years, one fewer person had kidney failure, a big loss of kidney function, or died from kidney or heart causes. The difference was clear enough that the trial was stopped early.¹³ This was in people who already had kidney disease, so it doesn't show the medicine protects healthy kidneys.

But vomiting or diarrhoea can dry you out, and that can damage the kidneys.¹²

Eyes. In a 2-year trial in people with type 2 diabetes, eye complications from retinopathy were more common on Ozempic than on a dummy injection. The gap was bigger in people who already had retinopathy.¹²

Out of every 100 people, how many had eye complications:

Bars for eyes are drawn on a scale up to 10 in 100.

Report any change in your vision.¹²

Will I lose as much weight as people without diabetes?

On average, people with diabetes lost less in trials. Two trials of semaglutide 2.4 mg, the weekly dose sold as Wegovy, each ran for 68 weeks (about 16 months).

Average share of body weight lost, and what that means for someone who starts at 90 kg (14 st 2 lb):

What this means. These are separate trials with different people, so the gap between them is a rough guide, not a direct comparison. They are averages too, so your own result may be higher or lower.

What to read next, in order

These four guides go deeper. Each one ends with a link to the next, so you can read them one after another.

1. 1Weight and health: what BMI and waist numbers meanGuide 1 of 9UnderstandHow weight links to diabetes, and why NICE uses lower BMI thresholds for some ethnic groups.
2. 2What do GLP-1 medicines do?Guide 2 of 9UnderstandHow these medicines release insulin only when sugar is high.
3. 3Side effects and risksGuide 5 of 9DecideStomach effects, and the risks that matter more with diabetes.
4. 4Getting a prescription in the UKGuide 6 of 9Do it safelyThe UK brands licensed for diabetes, who prescribes them, and what you pay in each nation.