UPDATE, 3rd January 2024: A new National Patient Safety Alert has been issued by NHS England and the Department for Health and Social Care to address supply issues with GLP-1 RA medication. This will open up new prescribing of Rybelsus (semaglutide) tablets to people living with type 2 diabetes who could benefit.
The NHS continues to face supply issues with glucagon-like peptide receptor agonists (GLP-1 RAs, or GLP-1 analogues), 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 exceeding supply.
We welcome the new National Patient Safety Alert (NPSA) issued on 4th January 2024, which says that there is now sufficient stock of Rybelsus (semaglutide) tablets to allow people with type 2 diabetes who could benefit to be newly initiated on this form of GLP-1 RA.
Previously (since the summer of 2023) all stocks of GLP-1 RAs had to be reserved for those already using these medications, meaning that thousands of people who could benefit from these medications were not able to access them.
What's the latest with the shortage of GLP-1 RAs?
A 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.
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 Department for Health and Social Care and NHS England have issued guidance to clinicians on what to do.
In September 2023, a separate brand of semaglutide was approved in 2023 for weight loss under the brand name Wegovy.
Novo Nordisk announced that through a ‘controlled and limited launch’, a supply of Wegovy will become available to people in specialist NHS weight management services who meet the NICE eligibility criteria, or privately through a registered healthcare professional.
You can read more about Wegovy, the NICE prescription eligibility criteria, and what to do if you want to be prescribed weight loss medication.
The new NPSA also now says that supply of GLP-1 RAs is not expected to return to normal until at least the end of 2024. Novo Nordisk, which manufactures Ozempic and Wegovy, has also advised that Ozempic is likely to be impacted by intermittent supply shortages running into 2025.
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
- Not to switch between drug brands once someone is established on one, or substitute with lower dosages
- Continuing to review the effectiveness of GLP-1 RAs in line with NICE guidance
- 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) produced guidance in 2023 which recommend supporting eligible people to access weight management and remission services.
Which drugs are impacted by the shortage?
The current shortages are impacting on supplies of most the GLP-1 RA medications which include Ozempic, Trulicity, Victoza, Saxenda, Byetta, and Bydureon.
The new alert directs clinicians to identify patients prescribed Byetta and Victoza injections and, in line with NICE guidance, switch them to Rybelsus tablets.
A limited amount of Wegovy and Saxenda is also available through specialist weight management services only.
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 and how the situation might be improved.
Douglas Twenefour, Head of Care at Diabetes UK, said:
“The ongoing shortages of some GLP-1 medications are having serious implications for many people with type 2 diabetes and are still a major concern. With these shortages likely to last for at least the rest of this year, this will have a significant impact on whether many people living with type 2 diabetes can access the best course of treatment for them.
“We fully support the instruction that GLP-1 medications should not be prescribed off-label under any circumstances while there is an ongoing shortage impacting people with type 2 diabetes.
"Anyone affected by these shortages should be contacted by their healthcare team to discuss finding the best course of treatment available. But if you are still concerned, you can ring the Diabetes UK helpline on 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.