Liraglutide for the treatment of type 2 diabetes mellitus

NICE technology appraisals [TA203] Published date:

NICE recommends liraglutide taken at a dose of 1.2 mg once a day as a possible treatment for some people with type 2 diabetes mellitus (see below). However, NICE does not recommend liraglutide taken at a higher dose of 1.8 mg once a day.

Who can have liraglutide?

You should be able to have liraglutide (at a dose of 1.2 mg once a day) when given with two other drugs for diabetes (that is, with a type of drug called metformin and either a type of drug known as a sulphonylurea or a thiazolidinedione), if your blood glucose level isn’t under control and:

  • you have a high body mass index (BMI 35 kg/m2 or higher1) and problems associated with high body weight or
  • your BMI is under 35 kg/m2 and losing weight would help other weight-related health problems, or taking insulin would greatly affect your ability to work.

You should be able to have liraglutide (at a dose of 1.2 mg once a day) when given with one other drug for diabetes (that is, with either metformin or a sulphonylurea) if:

  • you cannot take either metformin or a sulphonylurea for medical reasons, or you had to stop taking one of these drugs because you had a bad reaction to it, and
  • you cannot take both thiazolidinediones and dipeptidyl peptidase-4 (DPP-4) inhibitors for medical reasons, or you had to stop taking both of these types of drugs because you had a bad reaction to them.

You should be able to carry on taking liraglutide in these circumstances as long as it has helped to improve your diabetes sufficiently (that is, reduced your blood glucose levels, and helped you lose weight if needed) after 6 months of treatment.

Why has NICE said this?

NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS. NICE recommended liraglutide given with one other drug for diabetes in these circumstances because there is a clinical need for people whose only alternative is early treatment with insulin. NICE recommended liraglutide given with two other drugs for diabetes in these circumstances because its cost is justified by the benefits it provides. There was no evidence to show that liraglutide works better if the dose is increased from 1.2 mg to 1.8 mg, so NICE did not recommend the higher dose.

1 This figure is for people of European descent and should be adjusted for people from other ethnic groups.

Updates

Units for reporting HbA1c have changed from % to mmol/mol since this guidance was published. The NICE Pathway on diabetes has been changed to reflect this. The guidance is being updatedand the new recommendations (to be published in 2015) will use mmol/mol.

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