25 May 2016

Three new treatment options for type 2 diabetes recommended by NICE

Tens of thousands of people with type 2 diabetes will be eligible for new treatments under new guidance from NICE.

The drugs will help to control blood sugar in those patients who cannot take more commonly prescribed medicines meaning their condition remains stable for longer.

An estimated 31,000 people may be eligible for the three recommended treatments: canagliflozin (Invokana), dapagliflozin (Forxiga) and empagliflozin (Jardiance).

The three drugs can all be used on their own if a person can’t use metformin, sulfonylurea or pioglitazone, and diet and exercise alone isn’t controlling their blood glucose levels.  

In the UK, almost 3.5 million people who have been diagnosed with diabetes and it’s estimated that about 90% of adults with the condition have type 2 diabetes. 

Type 2 diabetes causes elevated blood sugar levels which damages blood vessels leading to increased risk of heart attack, stroke and limb amputation.

Sugar levels rise because their body doesn’t produce enough insulin – the hormone which controls the amount of glucose in blood – or their body doesn’t use insulin effectively.

Professor Carole Longson, director of the NICE Centre for Health Technology Evaluation, said: “Type 2 diabetes is long-term condition that has a serious impact on people who live with it, and the treatments given should be tailored for the individual.

“For many people whose blood glucose levels aren’t controlled by diet and exercise alone, metformin is the first drug treatment that they’ll be offered. But some people may experience nausea and diarrhoea, and they may not be able to take it if they have kidney damage. For people who can’t take a sulfonylurea or pioglitazone, then the three drugs recommended in this guidance can be considered.  This is as an alternative to the separate group of drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors.

“The committee agreed that people with diabetes and their clinicians would value having an additional treatment option to help manage their type 2 diabetes – which this positive guidance provides.”

“Good to have more treatment options”

Getting the right treatment to manage diabetes is important. If blood glucose levels are not managed effectively it causes tissue damage which can also result in blindness, kidney failure, and foot ulcers which can lead to amputation. Type 2 diabetes is more common in people of African, African Caribbean and South Asian family origin.

Ruth Waxman, who has type 2 diabetes and was a patient expert for the NICE guidance, said: “I am delighted with the decision by NICE to recommend three more drugs for diabetes.  Since I’ve been taking one of these drugs – dapagliflozin – my blood sugars have improved immensely and I am no longer stressed or anxious when I have the HbA1c test as I know the results will be good. 

“I am more confident, I feel better and have a more positive outlook knowing I can control my diabetes more efficiently and I am able to cope better with having diabetes.   

The fear of taking insulin or other injectables has disappeared.  It’s good to know that people with type 2 diabetes will now have more treatment options.”   

Simon O’Neill, Director of Health Intelligence and Professional Liaison at Diabetes UK, said: “We welcome the new guidance on using the SGLT-2 group of Type 2 diabetes medications as a monotherapy.

“This gives people with Type 2 diabetes and their healthcare team more options when metformin is not appropriate. We know that different people with Type 2 diabetes may respond favourably to different medications. 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.”

Access to these drugs is an advantage for people who can’t have metformin.

Mark Baker, Director of the Centre for Clinical Practice at NICE