Cost regulators for the NHS in England and Wales are backing the use of three monotherapies to treat patients with diabetes type 2: Janssen's Invokana, AstraZeneca's Forxiga and Boehringer Ingelheim/Lilly's Jardiance.

Metformin is usually the first drug treatment be offered to patients unable to maintain healthy blood glucose levels with diet and exercise alone, but some experience side effects such as nausea and diarrhoea, or may not be able to take it for other reasons.

For those who also can't take a sulfonylurea or pioglitazone, Invokana, Forxiga and Jardiance can now be considered as a possible treatment option, offering an alternative to the separate group of drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors.

"The committee agreed that people with diabetes and their clinicians would value having an additional treatment option to help manage their type 2 diabetes - which this positive guidance provides," noted Professor Carole Longson, director of the NICE Centre for Health Technology Evaluation.

The three drugs were cost effective compared with DPP-4 inhibitors with incremental cost effectiveness ratio (ICERs) of less than £29,300 per quality-adjusted life year (QALY) gained.

Almost 3.5 million people who have been diagnosed with diabetes in the UK, and it is estimated that around 90 percent of adults currently diagnosed have the type 2 form. An estimated 31,000 people may be eligible for the three recommended treatments.