New NHS diabetes strategy could raise GLP-1 drug use
New guidelines on NHS management of type 2 diabetes will introduce a more personalised approach that could see expanded access to drug treatments, including GLP-1 agonist therapies.
The shift from a 'one-size-fits-all' approach is designed to reduce the chances that patients with this most common form of diabetes will go on to develop heart failure, heart attacks, and other serious medical problems that cost the NHS an enormous amount to treat each year.
The change recognises that the majority of people with type 2 diabetes are not currently taking the most effective medication for them, with some people – women, older people, and Black or Black British individuals, for example – under-prescribed newer medicine classes.
Individualised care will take into account patients' "personal preferences, comorbidities and risks from polypharmacy, and their likelihood of benefiting from long-term interventions," according to the new draft guidance from health technology assessment (HTA) agency NICE, which was published this morning and still needs to go through consultation until early October.
Among the plans will be greater first-line use of SGLT-2 inhibitors or 'gliflozin' drugs, which are mainly used second-line under current protocols, and earlier use of GLP-1 receptor agonists like Novo Nordisk's liraglutide and semaglutide.
At the moment, the standard first-line drug treatment for type 2 diabetes is metformin, which has been used for decades but does not have the heart- and kidney-protecting qualities of the SGLT2 drugs. Around 2.3 million people will be eligible for the latter under the new guidance.
NICE said the new guidance is the "biggest shake-up in type 2 diabetes care in a decade" and is part of an effort to re-evaluate priority clinical pathways in alignment with the government's recently published NHS 10-Year plan.
It estimates that 22,000 lives could be saved by expanding the use of SGLT2 inhibitors alone, assuming they can reach 90% of eligible patients.
Meanwhile, the guidance also calls for type 2 diabetes with cardiovascular disease to be offered triple therapy that includes a GLP-1 agonist, while people diagnosed at an early age – below 40 – should get dual therapy "before a GLP-1 receptor agonist is considered."
All told, the expectation is that around 750,000 more people with type 2 diabetes could be offered GLP-1 drugs if the guidance is accepted in its current form.
"This long-awaited announcement propels type 2 diabetes treatment into the 21st century," said Douglas Twenefour, head of clinical at patient advocacy group Diabetes UK.
"Boosting access to newer treatments will be transformative for people with type 2 diabetes, while ensuring the UK keeps pace with the global momentum in treating the condition," he added.
