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Greater options for patients with type 2 diabetes
NICE has approved the use of exenatide in triple therapy regimens for patients with type 2 diabetes, in latest guidance.
Patients should be offered the drug if they are struggling to control their blood glucose levels or if they remain inadequate, defined as an HbA1c of 7.5 per cent or above, or other higher level as agreed with the individual.
Exenatide improves glycaemic control in a number of ways, such as by enhancing glucose-dependent insulin secretion to help lower the rise in blood sugar from eating.
The prolonged release suspension, which is recommended in the final guidance, is injected once weekly as opposed to twice a day for the conventional formulation.
Eligible patients should have a body mass index (BMI) of 35kg/m2 or higher in those of European family origin and specific psychological or medical problems associated withhigh body weight, or a BMI below 35 kg/m2 and therapy with insulin would have significant occupational implications or weight loss would benefit other significant obesity-related comorbidities.
Treatment with prolonged-release exenatide in a triple therapy regimen should only be continued if a beneficial metabolic response has been shown.
Exenatide can also be offered to some patients in dual therapy regimens, in combination with metformin or a sulphonylurea, but only if the patient is intolerant of either metformin or a sulphonylurea, or treatment with metformin or a sulphonylurea is contraindicated.
Patients must also be intolerant of thiazolidinediones and dipeptidyl peptidase-4 (DPP-4) inhibitors, or treatment with thiazolidinediones and DPP-4 inhibitors is contraindicated.
Professor Carole Longson, Director, Centre for Health Technology Evaluation at NICE said: “Type 2 diabetes is increasingly more common in the UK, and now affects 2.25 million people. It is a serious, progressive disease, so we are very pleased to be able to recommend prolonged-release exenatide as both a clinically and cost effective treatment option.”
A clinical audit tool, electronic audit tool and a costing statement are available to help put this guidance into practice.
For more information about this new guidance see the NICE website.
