A range of drugs used by people living with type 2 diabetes to lower their blood glucose levels is currently facing global shortages.
The shortage of glucagon-like peptide receptor agonists (GLP-1 RAs) is somewhat due to off label prescriptions of the drug semaglutide being increasingly used for weight loss, which it is not licensed for by the NHS.
Diabetes UK said: “We are urging clinicians to follow new Department for Health and Social Care guidance which states clinicians should not prescribe these drugs outside of their licensed use until the supply issues are rectified.”
Wegovy, a brand of semaglutide, has recently been approved for weight loss but had not yet been launched in the UK. Ozempic, another brand of semaglutide which is approved for use on the NHS to manage blood glucose levels in people with type 2 diabetes, is being increasingly prescribed off label for weight loss as a substitute to Wegovy.
The knock-on effect of this is that the supply of GLP-1 RAs is not meeting demand for people with type 2 diabetes. Novo Nordisk, which makes semaglutide, has estimated that this issue will likely continue until 2024 for all GLP1 RA prescriptions.
New guidance has been released by the Department for Health and Social Care and NHS England. It advises clinicians on actions they should follow until supply improves. It includes:
- Not to prescribe GLP-1 RAs outside of their approved use
- Avoid starting people with type 2 diabetes on any GLP-1 RAs
- Not to switch between drug brands or substitute with lower dosages
- Where alternative treatments need to be considered, discuss and agree a new management plan with those people affected.
Guidance has also been shared by The Primary Care Diabetes Society (PCDS) and Association of British Clinical Diabetologists (ABCD). According to Diabetes UK, they “recommend supporting eligible people to access weight management and remission services”.
Additionally, Diabetes UK is currently amid a discussion with the manufacturer and the Department for Health and Social Care regarding the impact of shortages on people with diabetes.
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Esther Walden, Deputy Head of Care at Diabetes UK, explained: “It is disappointing that the shortages are ongoing and are predicted to continue until at least mid-2024, but we welcome this guidance for clinicians.
“While we understand that off-label prescribing can be beneficial in some circumstances, we cannot support it when it is directly contributing to ongoing shortages for those people living with type 2 diabetes and the impact this has on managing it well. We would encourage clinicians to be mindful of this impact and prioritise helping people to manage their diabetes.
“People living with type 2 diabetes should be reassured that there are a number of alternative treatments available to help manage their condition. Healthcare professionals should work with patients to find the best course of treatment for them including non-medication based remission programmes where available, taking into account people’s individual needs and concerns.”
Diabetes UK have issued some advice for people whose prescriptions are affected by the shortage. It said: “We advise that you contact your healthcare team if you’re affected by shortages of GLP-1 analogues. These shortages mean that some people may need to change to a different medication or management plan. Your healthcare team should be able to discuss the options with you.”
Lower doses of GLP-1 must not be double as this will contribute to shortages. It is illegal to obtain GLP-1 RAs with no prescription and the medication may not be what it says it is, so GLP-1 RAs should only be obtained from registered pharmacies with a prescription.
