UPDATE, 20 MARCH 2024: NHS England has announced that Mounjaro can be prescribed to people living with type 2 diabetes if they are unable to access their GLP-1 RA medication and to people being newly initiated on a GLP-1.
We are pleased to see the opening up of Mounjaro as a treatment for people with type 2 diabetes. Though we remain concerned about the intermittent supply and ongoing shortages of glucagon-like peptide receptor agonists (GLP-1 RAs, or GLP-1 analogues), which are having serious implications for many people with type 2 diabetes.
In this guide:
- Why are there supply issues with GLP-1 RAs?
- Prescriptions
- Private prescriptions
- Other effects of stopping GLP-1s
- Possible end of shortage
- What are Diabetes UK doing?
Why are there supply issues with GLP-1 RAs?
The NHS is currently facing supply issues with 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.
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.
Prescriptions
I have been told there is no more supply of my GLP-1 RAs medication. Which of my medications is this?
There are different GLP-1 RAs for type 2 diabetes. They include:
- Dulaglutide (with the brand name Trulicity)
- Exenatide (with the brand name Byetta or Bydureon)
- Liraglutide (with the brand name Victoza)
- Lixisenatide (with the brand name Lyxumia)
- Semaglutide (with the brand name Ozempic or Rybelsus)
There is also semaglutide with the brand name Wegovy, but this is licensed for weight loss, not glucose management in type 2 diabetes.
My healthcare professional has stopped prescribing my GLP-1 RAs why is this?
There are three reasons why you might have been asked to stop your GLP-1 RA medication:
- Your healthcare professional has reviewed your response to this treatment and feels that it does not help you as intended.
- There may be supply issues, meaning that your medication is no longer available or likely to be out of stock for some time. There is a national shortage of these medications. Healthcare professionals are going to be reviewing people for alternative treatment where needed.
- You may have been previously prescribed this medication for an “off-label” use – these medications are only licensed for glucose management in type 2 diabetes (except for Wegovy).
Can I be switched onto a different GLP-1 RA?
Since the summer of 2023 this was not permitted due to the shortages, but this changed in January 2024 when a National Patient Safety Alert (NPSA) was issued directing clinicians to allow people with type 2 diabetes who could benefit to be newly initiated onto Rybelsus.
The NPSA said 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.
People who have been prescribed Byetta and Victoza injections can be identified and their treatment can be changed to Rybelsus tablets. This is because Byetta is being discontinued in March 2024 and Victoza (liraglutide) continues to be out of stock and further stock is not expected until end of 2024.
And in March 2024 NHS England confirmed that Mounjaro can be prescribed to people living with type 2 diabetes who are unable to obtain Ozempic, Trulicity or other GLP-1 medications, including people being newly initiated onto a GLP-1.
But in line with NICE guidance, your healthcare professional should still review whether the new medication is suitable for you before starting it and effective for you after you have started the treatment.
While I can get supply from the pharmacy, should I ask for a larger supply on prescription so that I don’t run out?
This is not recommended as supplies will run out much faster.
I was previously told that I would potentially need to start a GLP-1 RA at my next appointment, will that still happen?
The new guidelines for healthcare professionals now say that if you meet the NICE guidance criteria for a GLP–1 RA you could be newly prescribed Rybelsus or Mounjaro. If appropriate, your healthcare professional will discuss this at your next diabetes review.
What are the NICE guidance criteria?
NICE guidance for managing type 2 diabetes says that if triple therapy with metformin and two other oral drugs is not effective or not tolerated by the person taking the medication, healthcare professionals should consider triple therapy by switching one drug for a GLP-1 mimetic for adults with type 2 diabetes who:
- Have a body mass index (BMI) of 35 kg/m2 or higher (adjust accordingly for people from Asian, Black, and other minority ethnic groups) and specific psychological or other medical problems associated with obesity, or
- Have a BMI lower than 35 kg/m2, and when insulin therapy would have significant impact on their working life, or weight loss would benefit other significant obesity-related complications.
I still have supply of my GLP-1 RAs in the fridge, do I keep taking those for now?
Yes, continue to take your GLP-1 RA medication as normal and try to obtain re-supply as you usually would. If you have run out of GLP-1 RA and you can’t get re-supply as usual, it’s important to discuss this with your healthcare professional and find out if you have already been or are going to be prescribed an alternative treatment.
I have not had any problem obtaining supply of my GLP-1 RAs so far, when can I expect to be affected?
If you are established on a GLP-1 RA medication there is a chance that there will be intermittent supply of certain products. You should keep taking your medication as usual but contact your healthcare professional if you run into problems collecting your prescription.
I know someone who is managing to get their GLP-1 RA, how come I can’t get mine?
Different GLP-1 RAs are experiencing different types of shortages. Some GLP-1 RAs are still being supplied to people already established on these medicines in some areas. It should be noted though that there is no guarantee of continued supply with any of these medicines and because of this uncertainty it is advised not to switch between products.
Are there some areas that have a better supply, and should I consider driving to a pharmacy out of my local area to get my prescription filled?
People are advised not to attempt to get supplies from other areas as all areas across the UK are being affected by these shortages.
It is possible that some different areas may be better stocked than others at different times, but this is likely to be a temporary and changing as different areas will receive delivery of stock at different times. It is still likely that any supply will be short-lived as supply continues to be less than demand. Pharmacies are being asked not to stockpile.
My child takes a GLP-1 RA, what do I do?
Continue to give your child their GLP-1 RA medication as normal and try to obtain re-supply as you usually would. If you have run out of GLP-1 RA and can’t get re-supply as usual, get in contact with the team that usually looks after their care.
This only mentions type 2 diabetes, I have type 1 diabetes or pre-diabetes and have been prescribed this medication. Will the shortages affect me?
The recommendations during the shortages are that people with type 2 diabetes should be prioritised. We support this because the GLP-1 RAs are licenced for managing glucose levels in people living with type 2 diabetes.
If you are prescribed or trying to get a prescription to liraglutide (Saxenda) you may also be affected by these shortages. We don’t currently know how Saxenda prescriptions are being impacted.
In September 2023, Novo Nordisk announced that a limited 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.
People who are prescribed Wegovy within these specialist NHS services will also receive support with dietary information and exercise.
Wegovy cannot yet be prescribed outside of specialist weight management services, which are largely hospital based.
The National Patient Safety Alert issued on 4th January 2024 stated that Saxenda (liraglutide) and Wegovy (semaglutide) remain available on the NHS via specialist weight management services.
I am on a GLP-1 RA and I can’t obtain my supply. My healthcare professional has said they will review me, but it might be a few weeks, is that OK?
Due to the number of people affected by this shortage it is recommended that people who are most at risk should be prioritised. This may mean that some people may need to wait a little longer to be reviewed.
If I stop my GLP-1 RA, will I be allowed to restart it when it becomes available again?
Everyone with diabetes should have a review with their health care professional periodically, and at least once a year. When supplies are regularly available again, your healthcare professional can discuss with you whether you would benefit from re-starting your GLP-1 RA treatment.
If you have had a good response to previous treatment and you would benefit from re-starting treatment, this may be appropriate for you. However, not everyone gets the intended benefit of treatment and so it may be that your healthcare professional might advise an alternative for you. They may also suggest an alternative because of supply issues.
People can now be switched to Rybelsus and Mounjaro.
Am I better having it when I can get hold of it, even if that’s occasionally, rather than stopping entirely?
There is a chance that taking the medication sporadically may increase the risk of you experiencing side effects and may lead to unstable blood glucose levels. This could increase the likelihood of complications. This is of particular concern for people on insulin or sulphonylureas treatment, for example gliclazide or glimepiride.
Can I be prescribed a lower strength version of the GLP-1 RA and I double the dose instead?
No, this is not licenced and will reduce the remaining supplies for people established on the lower doses.
Private prescriptions
If I get GLP-1 RA on private prescriptions, am I likely to also have problems or is this just a problem for NHS supply?
There is a national shortage of these medication and there is no guarantee that private supply routes will continue. Healthcare professionals in the NHS can only advise about NHS prescriptions. You should contact your private practitioner if you want further information.
Should I buy GLP-1 RA privately?
It is not advised to pursue a private supply of these medications. There is no guarantee that there will be a continued supply privately and there is some concern that treatments being sold without a prescription may not be what they say they are.
Other effects of stopping GLP-1s
Will l gain weight when I stop the GLP-1 RA?
This will depend on if you lost weight when you started this medication. If you have lost weight, it increases the chance that weight will be regained after stopping. Talk to your healthcare professional to discuss alternatives such as weight management or remission programmes if you are concerned about weight gain.
Since stopping my GLP-1 RA I feel tired, thirsty and I am urinating a lot, what should I do?
These are the symptoms of high blood sugar levels and could lead to a serious condition called diabetic ketoacidosis (DKA). You should seek immediate medical attention.
Before I went on the GLP-1 RA I was told that I might have to go onto insulin, does that mean I will need to go onto insulin sooner?
Healthcare professionals will be prioritising people for review and will discuss with you your alternative treatment options. Treatment should be individualised for you and may involve other types of management such as changes to your diet or physical activity as well as a review of your medication.
I drive for a living and have been trying to avoid going on medications that cause hypoglycaemia, does this mean I am going to have to go onto something that will affect my driving licence?
You should raise any concerns about the impact on your driving licence with your healthcare professional and they will discuss with you your alternative treatment options. You can drive on a restricted licence even if you have a group 2 licence with both insulin and sulphonylureas, for example gliclazide and glimepiride.
Are there treatments I could try that do not involve taking more or different medication?
If you are concerned about taking alternative medication or putting on weight with a different medication you could ask your health care professional about referral to local or digital weight management programmes or a remission programme if it is relevant for you and available in your area.
You might also find diabetes education courses helpful if you have not done one for a while – ask your healthcare professional what is available locally. There are also now some digital courses available.
Possible end of shortage
When do you expect the shortages to come to an end?
Stock shortages are expected until at least the end of 2024.
What are Diabetes UK doing?
We are supporting the recent guidance and are having ongoing discussions with the manufacturer and the Department for Health and Social Care about our concerns over how this is impacting people with diabetes. If this shortage is impacting on your mental health and wellbeing you can call the Diabetes UK Helpline – call 0345 123 2399.
