UPDATE, 4 SEPTEMBER, 2023: Wegovy has been made available in the UK through a ‘controlled and limited launch’, Novo Nordisk has said. Read our guidance below on the rollout of Wegovy and the latest on supply issues of GLP-1 RAs in the UK.
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.
Wegovy is made available in the UK
Semaglutide was approved earlier this year by the National Institute of Health and Care Excellence (NICE) for weight loss under the brand name Wegovy.
And on 4 September 2023, Novo Nordisk announced that a limited supply 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.
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 (DHSC) and NHS England have issued guidance to clinicians on what to do.
The DHSC has advised that supply of GLP1-RAs is not expected to return to normal until at least mid-2024. Novo Nordisk has also advised that Ozempic is likely to be impacted by intermittent supply shortages running into 2025.
What is the latest guidance?
The 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 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.
We understand that only a limited amount of Wegovy will be available – and 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.
Douglas Twenefour, Head of Care at Diabetes UK, said:
“The ongoing shortages of GLP-1 medications, including Ozempic, are having serious implications for many people with type 2 diabetes and are a major concern.
"The situation is causing considerable stress and uncertainty for those affected and, in cases where no other alternatives are suitable, people are being moved on to insulin – which can be challenging to manage and requires additional time from healthcare professionals to support people to use it.
"We welcome the government’s guidance to prescribers and fully support the instruction that these medications should not be prescribed off-label under any circumstances while there is an ongoing shortage impacting people with type 2 diabetes.
“All existing stock must be conserved for people with type 2 diabetes and it is vital that the supply of these medications into the NHS is drastically improved before the winter, when NHS resources come under even more strain. We also want to see an increase in staff resource, to ensure there is greater support for people impacted by this issue and to safeguard against any further impact on routine diabetes care.
"We hope that the launch of Wegovy will – in time – ease some of the pressures on the supply of GLP- 1 medications by offering an option that is expressly for weight loss and therefore helping to reduce some off-label prescription of GLP-1 drugs licensed for type 2 diabetes.
"Anyone affected by these shortages should be contacted by their healthcare team to discuss finding the best courses 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.