Updated guidance from the PCDS and ABCD: Managing the national GLP-1 RA shortage

The ongoing global surge in demand for GLP-1 receptor agonists for both licensed and off-label indications continues to limit their availability in the UK. The Medicines and Healthcare products Regulatory Agency predicts that supply issues are unlikely to resolve before the end of 2024.

Although supplies of some GLP-1 RA preparations may be intermittent or exhausted within this time, there are now products available which can be used for new GLP-1 RA initiations and for switching people with type 2 diabetes who are unable to obtain their original GLP-1 RA medication. These agents include Rybelsus (oral semaglutide) and the novel first-in-class dual GIP/GLP-1 receptor agonist Mounjaro (tirzepatide), which is now available for use in the management of type 2 diabetes.

As a result of this, the PCDS and the Association of British Clinical Diabetologists have updated their joint guidance to assist healthcare professionals to overcome this particular challenge in the management of type 2 diabetes in adults.

The most recent update serves as a thorough guide to navigating the shortage, offering solutions to a range of dilemmas that could arise when treating a person who may benefit from a GLP-1 RA. Most importantly, it provides advice and tools to aid clinicians in selecting suitable alternatives to GLP-1 RAs where there is limited availability. It consolidates links to all essential documents and website references in one accessible location.

The following topics are covered:

●  Prescribing and deprescribing advice for clinicians.

●  Licensed indications for the use of alternative GLP-1 RAs or the dual GIP/GLP-1 RA tirzepatide.

●  Suggested actions when GLP-1 RAs are unavailable.

●  Practical and concise guidance for prescribers and patients for the administration and storage of medications.

●  Important considerations in people with diabetic retinopathy, including a user-friendly pathway.

●  Where insulin therapy is required.

●  Advice for patients.

●  Recommencing GLP-1 RAs when the shortage has passed.

●  A table summary of the glucose-lowering agents currently licensed for use in the UK, by class.