Draft guidance from the UK's National Institute for Health and Care Excellence (NICE) has proposed a significant shake-up of diabetes treatment, including earlier access to weight loss therapies and broader access to continuous glucose monitoring.
The guidance for the treatment of Type 2 diabetes, which was last updated in 2022, has proposed elevating funded access to SGLT-2 inhibitor medicines from second to first-line for patients in combination with metformin. It has also recommended faster access to GLP-1 receptor agonists to some groups of patients, including those with cardiovascular disease. It has maintained its previous guidance to fund continuous glucose monitoring devices for insulin-dependent Type 2 diabetics.
In Australia, the PBS subsidises SGLT-2 inhibitor medicines as a second-line treatment for patients with Type 2 diabetes, or as a first-line option for those with certain conditions, including cardiovascular disease, or where metformin is contraindicated.
Australia funds continuous glucose monitoring for all people with Type 1 diabetes. The Medical Services Advisory Committee is currently considering proposals to expand funding to include patients with insulin-dependent Type 2 diabetes.
"New evidence also suggests that nearly 22,000 lives could be saved once uptake of the recommended changes for SGLT-2 inhibitors, as a joint first-line treatment option with metformin, reaches 90% of the patient population," said NICE in a statement.
"These draft recommendations demonstrate how NICE is already delivering on commitments within the 10-year-plan by updating guidance to drive smarter NHS spending. This guidance means more people will be offered medicines where it is right to do so to reduce their future risk of ill health," said Professor Jonathan Benger, deputy chief executive and chief medical officer at NICE.
Professor Benger added, “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.
"The evidence shows that certain medicines can provide important cardiovascular benefits, and by recommending them as part of initial treatment, we could help prevent heart attacks, strokes and other serious complications before they occur. This is particularly important given that cardiovascular disease is the leading cause of death in people with type 2 diabetes.”
NICE’s independent guideline committee has expanded access to newer diabetes medicines called SGLT-2 inhibitors (with names like canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin) from being second-choice treatments to first-choice treatments. And some groups of patients stand to benefit from another type of medicine called GLP-1 receptor agonists (such as liraglutide or semaglutide), rather than keeping them for later stages of treatment.
For patients who cannot tolerate metformin (the traditional first diabetes medicine), the new guidelines recommend starting with an SGLT-2 inhibitor on its own. This is because growing evidence shows these medicines protect the heart and kidneys beyond just controlling blood sugar.
New evidence also suggests that nearly 22,000 lives could be saved once uptake of the recommended changes for SGLT-2 inhibitors, as a joint first line treatment option with metformin, reaches 90% of the patient population.