The NHS is currently facing supply issues with glucagon-like peptide receptor agonists (GLP-1 RAs), a range of drugs used for managing blood glucose levels in people with type 2 diabetes.
The global shortage in supply is partly due to a surge in off label prescriptions of the drug semaglutide being issued for weight loss which is outstripping supply.
We are urging clinicians to follow Department for Health and Social Care guidance which states clinicians should not prescribe these drugs outside of their licensed use until the supply issues are rectified.
We also welcome the patient safety alert from the MHRA on 18 July 2023, which states that existing stock must be conserved for use in people living with diabetes.
Why are there shortages?
Semaglutide has recently been approved for weight loss under the brand name Wegovy. However, this version of the drug has not yet been launched in the UK.
A separate brand of semaglutide, Ozempic, approved for use on the NHS as a treatment for managing blood glucose levels in people with type 2 diabetes, has increasingly been prescribed off label (outside of its approved license) for weight loss as an alternative to Wegovy.
This has created a knock-on effect for people with type 2 diabetes who are prescribed GLP-1 RAs as supply is not currently meeting demand. The company that makes semaglutide, Novo Nordisk, has stated that supply chain issues are unlikely to be resolved until 2024.
The Department for Health and Social Care and NHS England have issued new guidance to clinicians on what to do.
What is the latest guidance?
The new guidance outlines a set of actions for clinicians to follow until the shortages are resolved. These include:
- Not to prescribe GLP-1 RAs outside of their approved use
- Avoid starting people with type 2 diabetes on any GLP-1 RAs
- Not to switch between drug brands or substitute with lower dosages
- Where alternative treatments need to be considered, discuss and agree a new management plan with those people affected.
The Primary Care Diabetes Society (PCDS) and Association of British Clinical Diabetologists (ABCD) have also produced guidance which recommend supporting eligible people to access weight management and remission services.
Which drugs are impacted by the shortage?
It is expected that the current shortages will impact on supplies of all the GLP1 RA medications which include Ozempic, Rybelsus, Trulicity, Victoza, Saxenda, Byetta, and Bydureon.
Is it the same across the UK?
The shortages are having a global impact including across the UK. Scotland, Northern Ireland and Wales have all issued guidance which reflects that issued by the Department of Health and Social Care.
What are Diabetes UK doing?
We are supporting the recent guidance and are having ongoing discussion with the manufacturer and the Department for Health and Social Care about our concerns over how this is impacting people with diabetes.
Esther Walden, Deputy Head of Care at Diabetes UK, said:
“We are very concerned about these shortages, which are predicted to continue until at least mid-2024. We welcome this safety alert from the MRHA tasking local systems to take urgent action to plan for and mitigate the shortages.
"While we understand that off-label prescribing can be beneficial in some circumstances, we cannot support it when it is directly contributing to ongoing shortages for people living with type 2 diabetes and the impact this has on managing it well. These shortages have serious clinical implications in the management of people living with type 2 diabetes, both on physical and mental well-being, and existing stock must be conserved for their use.
“People living with type 2 diabetes should be reassured that there are a number of alternative treatments available to help manage their condition. Healthcare professionals should work with people living with diabetes to find the best course of treatment for them, including non-medication-based remission programmes where available, taking into account people’s individual needs and concerns.
“You should be in contact with your healthcare team if you are affected by these medication shortages. But if you are concerned or have questions about these shortages then you can ring our helpline – call 0345 123 2399.”
What to do if this affects your prescription
We advise that you contact your healthcare team if you’re affected by shortages of GLP-1 analogues. These shortages mean that some people may need to change to a different medication or management plan. Your healthcare team should be able to discuss the options with you.
Lower doses of GLP-1 should not be doubled up as this will contribute to the shortage of the medication and GLP-1 RAs should only be obtained on prescription from registered pharmacies and not be bought online without a prescription. It is not legal to obtain a GLP-1 RA without a prescription and there is a risk that the medicine may not be what it says it is.
You may be offered a diabetes review sooner than your next planned appointment. If your medication changes and you need support, ask your healthcare team about structured education and whether a referral to diabetes remission or weight management programme might be suitable for you.
If this shortage is impacting on your mental health and wellbeing you can call the Diabetes UK Helpline – call 0345 123 2399.