NHS relaxes rules on weight-loss jabs for millions of diabetes patients
The National Institute of Health and Care Excellence (Nice), the NHS medicines watchdog, has issued new draft guidance calling for the use of GLP-1 jabs, first developed for diabetes but now widely used for weight loss, to be ramped up significantly.
It means the majority of people in Britain with type 2 diabetes – around five million in total – could be given the drugs to help prevent further illnesses.
Experts hailed the proposed guidance as 'propelling treatment into the 21st century'.
Prof Jonathan Benger, the deputy chief executive and chief medical officer at Nice, said the changes would mean 'more people will be offered medicines where it is right to do so'.
He said: 'This represents a significant evolution in how we approach type 2 diabetes treatment.
'We're moving beyond simply managing blood sugar to taking a holistic view of a person's health, particularly their cardiovascular and kidney health.'
He added that by recommending both classes of drug sooner, the NHS 'could help prevent heart attacks, strokes and other serious complications before they occur'.
Drugs mimic hormones
Under the draft guidance, doctors will be able to give the revolutionary drugs – GLP-1 receptor agonists – to diabetes patients who also have heart disease or are obese.
They work by mimicking a hormone that regulates blood sugar and appetite.
It has since also been revealed that they could help with a range of conditions such as cancer, heart disease and even dementia.
Some 200,000 people are currently taking a GLP-1 injection on the NHS, three quarters of whom are using them for diabetes. The remainder are taking them for weight loss.
It is thought as many as 1.3 million people in the UK are on the jabs privately.
More than five million people in the UK are living with type 2 diabetes. It develops in adulthood and occurs when not enough of the hormone insulin is produced, leading to a rise in blood sugar levels.
The new NHS guidance says the jabs should be considered in diabetes patients who have also been diagnosed with heart disease, heart failure, or have early onset type 2, which means they were diagnosed before age 40.
People with both diabetes and obesity – a body mass index (BMI) over 35 – will also be able to get the jabs if they have not had success in bringing down their blood sugar levels within the first three months of using another drug.
While there are no public figures on eligibility, millions of patients could fall into the relevant categories.
It is common for people with diabetes to also suffer from heart issues and other related conditions, while up to 90 per cent are overweight or obese, with weight being the number one preventable cause of the condition.
Diabetes UK estimates 168,000 people have early onset type 2, while the condition also causes about 250,000 heart attacks, strokes or cases of heart failure, each year – the leading cause of death in diabetes patients.
Nice said the drugs were 'recommended as much for their cardiovascular benefits as for their glycaemic [blood sugar] benefits'.
It estimates that 655,000 people with heart disease could benefit from the drugs, as well as 99,000 with early onset type 2.
Nice said the initial rise in costs for the NHS would be offset in the longer term by reducing the need for other, sometimes more complex, treatment later on.
It was revealed last week that the price of Mounjaro privately would be more than doubled from Sept 1 to a wholesale price of up to £300. The NHS bracing for an increase in demand and more people are expected to turn to competitor Wegovy.
Some diabetes patients will already be eligible for, or taking, weight-loss jabs, on the NHS, but the draft guidance will mean more patients can access the drugs sooner without having to go to a specialist weight management service.
To qualify for weight-loss drugs on the NHS, a person must currently have a BMI of over 40 and four related health conditions to receive Mounjaro, or attend a specialist weight management service, where waiting times can be up to a year or longer, with a BMI of over 35 and one related condition, to receive Wegovy.
The draft guidance, which is out for consultation until October, also recommends making better use of another 'under-prescribed' class of drugs called SLGT-2 inhibitors.
These daily pills include canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. They reduce blood sugar levels by helping the kidneys remove glucose, which is passed from the body through urine.
The new guidelines recommend patients who cannot tolerate metformin – the first choice in type 2 diabetes medication – should start with an SGLT-2 inhibitor on its own.
Drugs could protect heart and kidneys
The watchdog said there was new evidence suggesting the drugs protect the heart and kidneys as well as controlling blood sugar, and could save almost 22,000 lives.
Douglas Twenefour, head of clinical at Diabetes UK, said: 'This long-awaited announcement propels type 2 diabetes treatment into the 21st century. 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.
'The majority of people with type 2 diabetes are not currently taking the most effective medication for them, putting them at risk of devastating diabetes-related complications. Diabetes is a leading cause of cardiovascular disease, and tailoring treatment based on individual risk could protect thousands against heart attacks and kidney disease.
'These guidelines could go a long way to easing the burden of living with this relentless condition, as well as helping to address inequities in type 2 diabetes treatments and outcomes.'
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