The NHS is currently grappling with significant supply issues regarding glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a critical class of drugs used to manage blood glucose levels in individuals with type 2 diabetes. This shortage has been exacerbated by a surge in off-label prescriptions of semaglutide for weight loss, which has far exceeded available supply.
Current Supply Situation
The shortage of GLP-1 RAs has been ongoing since the summer of 2023, with all available stocks initially reserved for existing patients, limiting access for new patients who could benefit from these medications. However, recent developments have provided some relief:
Rybelsus Availability: Earlier this year, supply of Rybelsus (oral semaglutide) improved, allowing new patients to be initiated on this medication.
Mounjaro Introduction: Mounjaro (tirzepatide) has become available as an alternative treatment for type 2 diabetes across the UK since March 2024.
Despite these improvements, intermittent shortages of injectable semaglutide (Ozempic) and other GLP-1 RAs are expected to persist into 2025. The Department for Health and Social Care and NHS England have emphasized that GLP-1 RAs should not be prescribed off-label, which could further exacerbate supply issues.
Guidance for Clinicians
In light of these shortages, updated guidance has been issued:
Prescribing Practices: GLP-1 RAs should only be prescribed for their licensed indications. Clinicians are advised not to double up on lower-dose preparations or switch between strengths solely based on availability.
Patient Management: Healthcare providers should proactively engage with patients affected by shortages, consider alternative medications like Rybelsus or Mounjaro, and ensure that patients are not intolerant to these options.
Prescription Limits: Prescriptions should not exceed one month’s supply unless absolutely necessary.
If the prescribed medication, such as Victoza, is unavailable for two weeks or more, clinicians should consider alternative options and liaise with specialists for further guidance.
Impact of Shortages
The current shortages are affecting most GLP-1 RA medications, including:
Ozempic: Injectable semaglutide
Trulicity: Dulaglutide
Victoza: Liraglutide
Saxenda: Liraglutide (for weight management)
A limited supply of Wegovy and Saxenda is available only through specialist weight management services for eligible patients.
Actions and Support from Diabetes UK
Diabetes UK is actively supporting the guidance issued and has engaged in ongoing discussions with manufacturers and the Department for Health and Social Care. Douglas Twenefour, Head of Care at Diabetes UK, highlighted the severe implications of these shortages and the importance of adhering to prescribed guidelines.
Patients affected by these shortages are encouraged to:
Contact Healthcare Teams: Discuss potential changes to medication or management plans with your healthcare team.
Avoid Online Purchases: GLP-1 RAs should only be obtained through registered pharmacies with a valid prescription. Avoid purchasing medications online, as there is a risk of counterfeit products.
Patients may also be offered earlier diabetes reviews and should explore structured education or referrals to diabetes remission or weight management programs if needed.
For further support, patients can contact the Diabetes UK helpline at 0345 123 2399.
Conclusion
The ongoing supply issues of GLP-1 medications underscore the critical need for careful management and adherence to prescribing guidelines. As the situation evolves, it remains essential for healthcare professionals to stay informed and support patients through these challenges.
Related topics:
Genetic Analysis Links Elevated Cytokines to Increased Risk of Gestational Diabetes
Higher Diligence Linked to Reduced Cardiovascular Risk in Type 2 Diabetes Patients
Eating Fruit, Oats, and Rye in Childhood May Increase Type 1 Diabetes Risk
