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

Authors

  • Ken y Thong School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
  • Piya S Gupta Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  • Melissa L Cull Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  • Karen A Adamson St John's Hospital, Livingston, UK
  • David S Dove Heatherwood and Wexham Park Hospitals NHS Foundation Trust, Wexham, UK
  • Susannah V Rowles Pennine Acute Hospitals NHS Trust, Greater Manchester, UK
  • Stephanie Tarpey Pennine Acute Hospitals NHS Trust, Greater Manchester, UK
  • Catriona Duncan Victoria Hospital, Kirkcaldy, UK
  • John Chalmers Victoria Hospital, Kirkcaldy, UK
  • Roy Harper The Ulster Hospital, Dundonald, UK
  • Paula Mcdonald The Ulster Hospital, Dundonald, UK
  • Ursula Brennan he Ulster Hospital, Dundonald, UK
  • Chris Walton Hull Royal Infirmary, Hull, UK
  • Robert EJ Ryder Hull Royal Infirmary, Hull, UK

DOI:

https://doi.org/10.15277/bjdvd.2014.015

Abstract

Injectable glucagon-like peptide-1 receptor agonists (GLP-1ras) have the distinct advantage of promoting weight loss as well as lowering glucose in type 2 diabetes. Treatment with a GLP-1ra is costly, thereby necessitating a restriction on widespread use, thus in the UK the National Institute for Health and Care Excellence (NICE) has published guidance on the use of these drugs.

In the UK the Association of British Clinical Diabetologists (ABCD) conducted two nationwide audits on the use of exenatide twice daily and liraglutide once daily and noticed that deviations from NICE guidelines were common. Herein data have been used from both audits (following a combined total of 12,955 type 2 diabetes patients) to evaluate these treatment decisions, critically appraise the NICE guidelines and formulate recommendations for the use of GLP-1ras.

Author Biography

John Chalmers, Victoria Hospital, Kirkcaldy, UK

The Ulster Hospital, Dundonald, UK

References

European Medicines Agency. Byetta: EPAR - Summary for the public. 2009. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/000698/WC500051840.pdf) (accessed January 2014).

European Medicines Agency. Victoza: EPAR - Summary for the public. 2009. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/001026/WC500050013.pdf (accessed January 2014).

Russell-Jones D, Gough S. Recent advances in incretin-based therapies. Clin Endocrinol 2012;77:489-9. http://dx.doi.org/10.1111/j.1365-2265.2012.04483.x

National Institute for Health and Care Excellence. http://www.nice.org.uk/(accessed January 2014).

NICE short clinical guideline 87. Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes. 2009. www.nice.org.uk/CG87shortguideline (accessed January 2014).

NICE technology appraisal guidance 203. Liraglutide for the treatment of type 2 diabetes. 2010. http://guidance.nice.org.uk/TA203 (accessed January 2014).

Sinha A, Rajan M, Hoerger T, Pogach L. Costs and consequences associated with newer medications for glycemic control in type 2 diabetes. Diabetes Care 2010;33:695-700. http://dx.doi.org/10.2337/dc09-1488

Wilding JPH, Hardy K. Glucagon-like peptide-1 analogues for type 2 diabetes. BMJ 2011;342:d410. http://dx.doi.org/10.1136/bmj.d410

Woehl A, Evans M, Tetlow AP, McEwan P. Evaluation of the cost-effectiveness of exenatide versus insulin glargine in patients with sub-optimally controlled Type 2 diabetes in the United Kingdom. Cardiovasc Diabetol 2008;7:24. http://dx.doi.org/10.1186/1475-2840-7-24

Waugh N, Cummins E, Royle P, et al. Newer agents for blood glucose control in type 2 diabetes: systematic review and economic evaluation. Health Technol Assess 2010;14:1-248.

Davies MJ, Chubb BD, Smith IC, Valentine WJ. Cost-utility analysis of liraglutide compared with sulphonylurea or sitaglitpin, all as add-on to metformin monotherapy in type 2 diabetes mellitus. Diabet Med 2012; 29:313-20. http://dx.doi.org/10.1111/j.1464-5491.2011.03429.x

The National Collaborating Centre for Chronic Conditions. Type 2 diabetes: National clinical guideline for management in primary and secondary care (update). London: Royal College of Physicians. 2008. http://guidance.nice.org.uk/CG66/Guidance/pdf/English (accessed 27 January 2014).

Shyangdan D, Cummins E, Royle P, Waugh N. Liraglutide for the treatment of type 2 diabetes. Health Technol Assess 2011;15:77-86.

Ryder REJ, Thong KY, Cull ML, et al. The Association of British Clinical Diabetologists (ABCD) nationwide exenatide audit. Pract Diab Int 2010; 27:352-357b. http://dx.doi.org/10.1002/pdi.1522

Thong KY, Jose B, Sukumar N, et al. Safety, efficacy and tolerability of exenatide in combination with insulin in the Association of British Clinical Diabetologists nationwide exenatide audit. Diabetes Obes Metab 2011; 13:703-10. http://dx.doi.org/10.1111/j.1463-1326.2011.01393.x

European Medicines Agency. Byetta-H-C-698-II-29: EPAR – Assessment Report – Variation. 2012. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Assessment_Report_-_Variation/human/000698/WC500128211.pdf (accessed January 2014).

Nolan CJ, Damm P, Prentki M. Type 2 diabetes across generations: from pathophysiology to prevention and management. Lancet 2011;378: 169-81. http://dx.doi.org/10.1016/S0140-6736(11)60614-4

Thong KY, Jose B, Blann AD, et al. Response at 3 months to insulin dose decisions made at exenatide initiation in the Association of British Clinical Diabetologists (ABCD) nationwide exenatide audit. Diabetes Res Clin Pract 2011;93:e87-91. http://dx.doi.org/10.1016/j.diabres.2011.05.015

Thong KY, Ryder RE, Cull ML, et al. Insulin avoidance and treatment outcomes among patients with a professional driving licence starting glucagon-like peptide-1 (GLP1-) agonists in the Association of British Clinical Diabetologists (ABCD) nationwide exenatide and liraglutide audits. Diabet Med 2012;29:690-2. http://dx.doi.org/10.1111/j.1464-5491.2011.03475.x

Ryder REJ, Sen-Gupta P, Thong KY, ABCD nationwide liraglutide audit contributors. Liraglutide is effective across a range of obese body mass indices; findings from the Association of British Clinical Diabetologists (ABCD) nationwide liraglutide audit. Diabetologia 2012;55[Suppl1]: S330 (Poster 801).

Norris SL, Lee N, Thakurta S, Chan BK. Exenatide safety and efficacy: a systematic review. Diabet Med 2009;26:837-846. http://dx.doi.org/10.1111/j.1464-5491.2009.02790.x

Zinman B, Schmidt WE, Moses A, et al. Achieving a clinically relevant composite outcome of an HbA1c of <7% without weight gain or hypoglycaemia in type 2 diabetes: a meta analysis of the liraglutide clinical trial programme. Diabetes Obes Metab 2012;14:77-82. http://dx.doi.org/10.1111/j.1463-1326.2011.01493.x

Gentilella R, Bianchi C, Rossi A, Rotella CM. Exenatide: a review from pharmacology to clinical practice. Diabetes Obes Metab 2009;11:544-56. http://dx.doi.org/10.1111/j.1463-1326.2008.01018.x

Marre M, Shaw J, Brändle M, et al. Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with type 2 diabetes (LEAD-1 SU). Diabet Med 2009;26:268-78. http://dx.doi.org/10.1111/j.1464-5491.2009.02666.x

Garber A, Henry R, Ratner R, et al. Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomized, 52-week, phase III, double-blind, parallel-treatment trial. Lancet 2009;373: 473-81. http://dx.doi.org/10.1016/S0140-6736(08)61246-5

Zinman B, Gerich J, Buse JB, et al. Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 MET+TZD). Diabetes Care 2009;32:1224-30. http://dx.doi.org/10.2337/dc08-2124

Russell-Jones D, Vaag A, Schmitz O, et al. Liraglutide vs insulin glargine and placebo in combination with metformin and sulfonylurea therapy in type 2 diabetes mellitus (LEAD-5 met+SU): a randomized controlled trial. Diabetologia 2009;52:2046-55. http://dx.doi.org/10.1007/s00125-009-1472-y

Buse JB, Rosenstock J, Sesti G, et al. Liraglutide once a day versus exenatide twice a day for type 2 diabetes: a 26-week randomized, parallel-group, multinational, open-label trial (LEAD-6). Lancet 2009;374:39-47. http://dx.doi.org/10.1016/S0140-6736(09)60659-0

Rosenstock TR, Shenouda SK, Bergenstal RM, et al. Baseline factors associated with glycaemic control and weight loss when exenatide twice daily is added to optimized insulin glargine in patients with type 2 diabetes. Diabetes Care 2012;35:955-58. http://dx.doi.org/10.2337/dc11-1434

DeFronzo RA, Stonehouse AH, Han J, Wintle ME. Relationship of baseline HbA1c and efficacy of current glucose-lowering therapies: a meta-analysis of randomized clinical trials. Diabet Med 2010;27:309-17. http://dx.doi.org/10.1111/j.1464-5491.2010.02941.x

Deacon CF, Mannucci E, Ahrén B. Glycaemic efficacy of glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors as add-on therapy to metformin in subjects with type 2 diabetes - a review and meta analysis. Diabetes Obes Metab 2012;14:762-67. http://dx.doi.org/10.1111/j.1463-1326.2012.01603.x

SIGN 116 Management of diabetes: A national clinical guideline. 2010. www.sign.ac.uk/pdf/sign116.pdf (accessed January 2014).

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Published

2014-06-09

Issue

Vol. 14 No. 2 (2014)

Section

Learning from practice

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