Clinicians now have more choice when it comes to treating type 2 diabetes after three drugs were given the official stamp of approval for use by the NHS in England and Wales.
Final guidance issued today by the National Institute of Health and Care Excellence said canagliflozin (Invokana), dapaglifloxin (Forxiga) and empagliflozin (Jardiance) can be prescribed on their own in certain circumstances.
“This guidance offers more choice for clinicians to individualise the care they provide”
NICE said they were suitable alternative treatments if changes to a patient’s diet and exercise were insufficient to control their blood glucose levels and they were unable to use metformin, or it was inappropriate to prescribe a sulfonylurea or pioglitazone.
It said the three drugs – which are sodium-glucose contransporter 2 (SGLT-2) inhibitors – were also a viable alternative to a separate group of drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors. All three block the reabsorption of glucose in the kidneys and promote excretion of excess glucose in urine.
“For many people whose blood glucose levels aren’t controlled by diet and exercise alone, metformin is the first drug treatment they’ll be offered,” said Professor Carole Longson, director of the NICE Centre for Health Technology Innovation.
“But some people may experience nausea and diarrhoea and they may not be able to take it if they have kidney damage,” she noted.
She highlighted that the three drugs covered by the new guidance could also be considered for patients who cannot take a sulfonylurea, that increases insulin release from the pancreas, or pioglitazone, which lowers blood glucose by making the body more sensitive to insulin.
Around three million people in the UK have type 2 diabetes and an estimated 31,000 may be eligible for the three recommended treatments.
NICE said the cost of a course of treatment over one year with each drug is around £475.
Douglas Twenefour, deputy head of care at Diabetes UK, welcomed the new guidance. “This gives people with type 2 diabetes and their healthcare team more options when metformin is not appropriate,” he said.
“We know different people with type 2 diabetes may respond favourably to different medications,” he said. “So this guidance offers more choice for clinicians to individualise the care they provide, which can have a significant impact on the quality of life of some people with type 2 diabetes.”