As part of NICE’s commitment to re-evaluate priority clinical pathways, the organisation is recommending more personalised treatment plans for Type 2 diabetes.
The National Institute for Health and Care Excellence (NICE) is moving away from a one-size-fits-all approach, shifting from automatically starting everyone on one medicine to personalised treatment plans that aim to prevent heart failure, heart attacks and other serious medical problems.
NICE’s independent guideline committee has expanded access to newer diabetes medicines called SGLT-2 inhibitors from being second-choice treatments to first-choice treatments. And some groups of patients will have access to GLP-1 receptor agonists rather than keeping them for later stages of treatment.
“This represents a significant evolution in how we approach Type 2 diabetes treatment. We’re moving beyond simply managing blood sugar to taking a holistic view of a person’s health, particularly their cardiovascular and kidney health,” said Jonathan Benger, deputy chief executive and chief medical officer at NICE.
“The evidence shows that certain medicines can provide important cardiovascular benefits, and by recommending them as part of initial treatment, we could help prevent heart attacks, strokes and other serious complications before they occur. This is particularly important given that cardiovascular disease is the leading cause of death in people with type 2 diabetes.”
Under-prescription
The guidelines also address concerns about under-prescribing of SGLT-2 inhibitors. Following an analysis of almost 590,000 people, NICE found that these medicines are not being offered equitably across the UK. SGLT-2 inhibitors are under-prescribed, particularly to women, older people, and Black or Black British individuals.
The draft guidelines suggest that adults with cardiovascular disease should be offered triple therapy including a GLP-1 receptor agonist; adults with early onset Type 2 diabetes should be offered dual therapy before a GLP-1 receptor agonist is considered; people living with obesity should receive specific treatment combinations; those with chronic kidney disease should have tailored recommendations based on their kidney function; and adults with frailty should be considered for metformin alone initially.
New evidence suggests that nearly 22,000 lives could be saved once uptake of the recommended changes for SGLT-2 inhibitors, as a joint first-line treatment option with metformin, reaches 90% of the patient population.
Around 4.6 million people are diagnosed with diabetes in the UK, according to Diabetes UK, with about 90% of those having Type 2. Additionally, it is estimated that almost 1.3 million people in the UK are likely to have undiagnosed Type 2 diabetes.
