UPDATE, 20 MARCH 2024: People in England and Northern Ireland living with type 2 diabetes can now be prescribed Mounjaro as a diabetes treatment, or offered Mounjaro if they are unable to access their usual GLP-1 RA medication. Mounjaro can be prescribed to people living with type 2 diabetes in England who are unable to obtain Ozempic, Trulicity or other GLP-1 medications.
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.
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.
In January this year, an increase in supply of Rybelsus meant that people could be newly initiated on a GLP-1. And we are now pleased to see NHS England opening up Mounjaro as a treatment for people with type 2 diabetes.
Mounjaro has been approved by the National Institute for Health and Care Excellence (NICE) for use within England and Wales and Northern Ireland are following the NICE recommendation.
Though we remain concerned about the intermittent supply and ongoing shortages of GLP-1 medications which are having serious implications for many people with type 2 diabetes.
What's the latest with the shortage of GLP-1 RAs?
There is still intermittent supply and shortages of some GLP-1 analogues including Ozempic, (injectable semaglutide), and some of these are expected to run into 2025. But there is now good supply of Rybelsus (oral semaglutide) and Mounjaro (tirzepatide).
Mounjaro can now be prescribed in line with NICE recommendations announced in October 2023.
There is still concern that off-label prescribing of GLP-1s will worsen the shortages and Department for Health and Social Care and NHS England say that all these medications should not be prescribed off-licence.
In September 2023, a separate brand of semaglutide was approved 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.
We are still waiting for the outcome of a NICE review on Mounjaro for weight loss.
What is the latest guidance?
New guidance has come this year through a National Patient Safety Alert in January 2024 and a Medicines Safety Notice in March 2024, which outlines a set of actions for clinicians to follow until the shortages are resolved. These include only prescribing GLP-1 RAs for their licensed indication.
Clinicians are also encouraged to proactively engage with people established on GLP-1 RAs who are impacted by the shortages, and consider prioritising them for review based on the criteria set out in clinical guidance, and:
- Discuss stopping the GLP-1 RA if treatment goals have not been achieved
- Avoid doubling up a lower dose preparation where a higher dose preparation of a GLP-1 RA is not available
- Do not switch between strengths of a GLP-1 RA solely based on availability
- Do not prescribe more than one month’s supply unless there is clear reason to do so.
Where someone is prescribed Victoza or Byetta, or where someone with diabetes is unable to obtain Ozempic or Trulicity for two weeks or more, prescribers should:
- Consider prescribing either Rybelsus tablets or Mounjaro KwikPens, and ensure the person with diabetes is prescribed appropriate needles
- If prescribing Mounjaro or Rybelsus, ensure that the person with diabetes is not intolerant to the medication
- If the above options are not considered appropriate, or if prescribers in primary care require further clinical advice, they should liaise with specialists on management options.
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. They have issued further guidance on prescribing Mounjaro.
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.
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 we have had ongoing discussions with manufacturers 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 an significant impact on whether some 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.
"We welcome the increased supply of Rybelsus announced earlier this year and the recent introduction of Mounjaro – which offer the chance for people with type 2 diabetes who meet the criteria to be now be started on a GLP-1 medication.
"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.
