GLP-1 receptor agonists in type 2 diabetes - NICE guidelines versus clinical practice

Thong, Ken; Gupta, Piya Sen; Cull, Melissa L.; Adamson, Karen; Dove, David; Rowles, Susannah; Tarpey, Stephanie; Duncan, Catriona; Chalmers, John; Harper, Roy; McDonald, Paul C.; Brennan, Ursula; Walton, Chris; Ryder, Robert E.

doi:10.15277/bjdvd.2014.015

Cited by 26 publications

(28 citation statements)

References 23 publications

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“…The advice to use the least expensive option at first appears sensible, but evidence is emerging that there are clinically important differences between the shorter and longer duration agents. 15,16 Customising GLP-1ra to patients' needs may be an important part of their effective and safe use in therapy. Advising the use of GLP-1ra (or DPP-4 inhibitors) with the lowest acquisition costs might also be problematic given the more limited licence, differences in recommendations in patients with renal impairment and the much smaller worldwide clinical experience when compared with more expensive agents from the same class.…”

Section: Incretin-based Therapiesmentioning

confidence: 99%

“…Common sense supports reviewing the efficacy of these relatively expensive treatments, but with a balanced approach. 16 We also take issue with the recommendation that GLP-1ra/insulin combinations can only be commenced within specialist care. This combination is much easier to use than insulin intensification regimes, which many GPs undertake frequently.…”

Section: Incretin-based Therapiesmentioning

confidence: 99%

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The new NICE guidelines for type 2 diabetes – a critical analysis

et al. 2015

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The latest NICE guidelines for the management of type 2 diabetes are now available for consultation. They contain sensible recommendations regarding lifestyle, patient education, monitoring and targets.Unfortunately, the pharmacotherapy section shows a distinct failure of common sense. The recommendations include using the insulin secretagogue repaglinide as a firstline agent, where metformin is not tolerated or contraindicated, or second-line in combination with metformin. Pioglitazone is recommended as the principal second-line therapy with metformin. The advice on glucagon-like peptide-1 receptor agonist (GLP-1ra) usage and assessment of efficacy and failure to recommend long acting analogue insulins over isophane are also major concerns.The recommendations appear to be based on metaanalyses and pharmacoeconomics, driven by an imperative on costs and failing to appreciate the "value" of the options under consideration. The cost to patients and the health service of the serious side-effects of these treatments is underestimated.Given the emphasis in these guidelines on the importance of lifestyle changes, including weight loss, plus an over-riding need to avoid hypoglycaemia, these pharmacotherapeutic recommendations appear paradoxical in the extreme.We believe that these recommendations, if enacted, will undermine seriously the reputation of NICE both nationally and internationally. Br J Diabetes Vasc Dis 2015;15:3-7

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Section: Incretin-based Therapiesmentioning

confidence: 99%

Section: Incretin-based Therapiesmentioning

confidence: 99%

The new NICE guidelines for type 2 diabetes – a critical analysis

et al. 2015

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“…57 It was found that GLP-1RA treatments were more effective in non-insulin treated patients than in insulin treated patients. 82 Although approximately 60% of the patients in both audits achieved reductions in both HbA1c and weight, only 25% in the liraglutide audit and 29% in the EBID audit met the NICE criteria of HbA1c reduction ≥1% and weight reduction >3% to continue GLP-1 treatment. 82 GI side effects were reported to be higher with EBID (24%) than with liraglutide (16%).…”

Section: Real Life Clinical Experience Of Glp-1 Use In the Ukmentioning

confidence: 98%

“…82 Although approximately 60% of the patients in both audits achieved reductions in both HbA1c and weight, only 25% in the liraglutide audit and 29% in the EBID audit met the NICE criteria of HbA1c reduction ≥1% and weight reduction >3% to continue GLP-1 treatment. 82 GI side effects were reported to be higher with EBID (24%) than with liraglutide (16%). 81 Both EBID and liraglutide treatment were associated with a reduction in SBP, total cholesterol and triglycerides.…”

Section: Real Life Clinical Experience Of Glp-1 Use In the Ukmentioning

confidence: 98%

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Glucagon like peptide-1 receptor agonist (GLP-1RA) therapy in management of type 2 diabetes: choosing the right agent for individualised care

et al. 2016

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Glucagon like peptide-1 receptor agonists (GLP-1RAs) are a new class of injectable agent used in the management of type 2 diabetes (T2DM). In the UK, NICE approved the use of GLP-1RAs in combination with metformin and sulphonylurea in people with T2DM whose glycaemic control is above target (≥7.5%, 58 mmol/mol) and body mass index (BMI) ≥35 kg/m 2 with other medical problems associated with obesity or for whom insulin therapy would have significant occupational implications or weight loss would benefit other significant obesityrelated comorbidities in people with BMI <35 kg/m 2 . Unlike many other classes of glucose lowering agents, GLP-1RAs not only improve glycaemic control but also promote weight loss with a low risk of hypoglycaemia. In randomised controlled trials, treatment with GLP-1RAs either as monotherapy or in combination with oral hypoglycaemic agents or insulin, has demonstrated significant improvement in glycaemic control by 1-2% with weight loss of approximately 1-5 kg. In addition, they exert a positive effect on cardio-metabolic risk factors by reducing body weight, lowering blood pressure and improving the lipid profile. Gastrointestinal side effects are the most common adverse events with GLP-1RA therapy. Since the first GLP-1RA was approved in 2005, a number of other GLP-1RAs are now available. However, their glycaemic efficacy, safety profiles and mode of delivery differ, and this review article aims to give an overview of differences among GLP-1RAs and to provide decision makers with an overview of the evidence when choosing a particular GLP-1RA for individualised therapy. Br J Diabetes 2016;16:128-137

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Real‐world GLP‐1 RA therapy in type 2 diabetes: A long‐term effectiveness observational study

Tofé

Argüelles

Mena

et al. 2018

Endocrino Diabet & Metabol

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Summary Aims To evaluate in a real‐world setting the effectiveness and tolerability of available GLP‐1 RA drugs in patients with type 2 diabetes after a prolonged follow‐up. Materials and methods Observational, retrospective, single‐centre study in patients starting GLP‐1 RA therapy. Change in HbA1c, fasting plasma glucose (FPG) and body mass index (BMI) along with gastrointestinal (GI) adverse events and withdrawal from GLP‐1 RA therapy were evaluated. Lack of efficacy of GLP‐1 RA therapy according to prespecified goals was also measured. Results A total of 735 patients were included, mean age 59.7 years, duration of diabetes 9.01 years, HbA1c 8.18% and BMI 38.56 kg/m 2 . Average follow‐up was 18.97 months (range 4.2‐39.09). All HbA1c (0.93%; P < 0.01), FPG (24 mg/dL; P < 0.01) and BMI (1.55 kg/m 2 ; P < 0.05) were significantly reduced from baseline and maintained throughout follow‐up, regardless of prescribed GLP‐1 RA. GI adverse events were present in 13.81% of patients at first follow‐up visit, 37.07% of patients discontinued GLP‐1 RA treatment, and 38.63% did not meet efficacy goals. Conclusions In a real‐world setting, GLP‐1 RA therapy is largely prescribed in severely obese patients with a long‐standing and poorly controlled diabetes. All prescribed GLP‐1 RAs significantly decreased HbA1c, FPG and BMI. GI adverse events affected a low proportion of patients. Inversely, a high proportion of patients did not meet efficacy goals and/or discontinued GLP‐1 RA treatment. Baseline characteristics of patients and lack of adherence may represent important issues underlying differences in effectiveness in real‐world studies versus randomized trials.

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GLP-1 receptor agonists in type 2 diabetes - NICE guidelines versus clinical practice

Cited by 26 publications

References 23 publications

The new NICE guidelines for type 2 diabetes – a critical analysis

The new NICE guidelines for type 2 diabetes – a critical analysis

Glucagon like peptide-1 receptor agonist (GLP-1RA) therapy in management of type 2 diabetes: choosing the right agent for individualised care

Real‐world GLP‐1 RA therapy in type 2 diabetes: A long‐term effectiveness observational study

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