Patients with type 2 diabetes on semaglutide and other glucagon-like peptide-1 receptor agonists (GLP-1 RA) drugs are having to stop taking them, amidst ongoing shortages due to popularity for weight loss.
A National Patient Safety Alert this week asked clinicians to proactively identify patients established on all GLP-1 RAs for review due to ‘very limited, intermittent supplies’ expected to last until the middle of next year.
This should include discussing stopping treatment with patients who have not achieved treatment targets as per NICE guidelines.
The alert also reiterated that until supply issues have been resolved the drugs should only be used for their licensed indication and off-label prescribing for obesity is ‘strongly discouraged’.
It follows a warning from the RCGP that unregulated use of semaglutide is posing ‘a genuine threat to patient safety’.
GPs were first advised to start no new patient on the drugs back in Autumn as global demand outstripped supply.
In the latest alert, clinicians are also asked not to switch patients between different brands – including between injectable and oral forms – and not to double up on lower dose preparations.
It added: ‘If switching a patient on to insulin, please ensure an insulin is chosen as per information on the SPS page on prescribing available insulins as not all suppliers are able to manage an uplift in demand.’
And it advised that moving to insulin will require education and training alongside increased glucose monitoring to ensure patients understand how to recognise and manage hypoglycaemic events.
‘Existing stock must be conserved for use in patients with diabetes. These shortages have serious clinical implications in the management of patients with type 2 diabetes,’ the NPSA warned.
A Department of Health and Social Care spokesperson said they expected all providers of healthcare services – NHS or private – to take ‘appropriate account’ of national guidance such as National Patient Safety Alerts and Medicine Supply Notifications.
‘The guidance is clear that these medicines should only be prescribed for the treatment of type 2 diabetes, in order to protect supply for diabetes patients.
‘Medicines which are solely licensed to treat type 2 diabetes should not be routinely prescribed for weight loss.’
Esther Walden, deputy head of Care at Diabetes UK, said: ‘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.’
Dr Douglas Price, a GP in Staffordshire, said: ‘It has caused some extra work swapping patients over to trulicity which is still in stock or switching to other classes of medications. Most of our patients who are on GLP1-RA are on trulicity (Dulaglutide), if that also becomes scarce it will be much more of a problem.
He added that the logistics of introducing semaglutide for weight loss in the UK seemed ‘poorly planned’.
‘It should’ve been clear to anyone that a once weekly weight loss medication is going to be popular. Private online providers, often it seems using GPs to prescribe, don’t have anywhere near the same hoops to jump through and patients simply populate an e-consult and pay the fee.
‘To be honest even if there was stock, NHS patients in our area wouldn’t have access to the medication for weight loss as our ICB yet to commission a weight loss service that can initiate it.’