By Richard Thomas

The national shortage of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is not expected to resolve until mid-2024, according to specialist clinicians working in the diabetes field.

Although other GLP-1 RA therapies may be available, it is possible there will be insufficient additional capacity to accommodate switching everyone with type 2 diabetes currently prescribed an affected GLP-1 RA to an alternative brand, say the Primary Care Diabetes Society (PCDS) and Association of British Clinical Diabetologists (ABCD).

The two bodies say they are “very concerned” about the situation. “This is very difficult for people with diabetes who are unable to access their GLP-1 RA medication, and for their clinicians who are unable to provide the treatment they feel is necessary.

“The need to consider switching or starting alternative therapies may have a significant impact on workload for primary care and community and specialist diabetes teams, and may cause people with diabetes anxiety and concern,” they add.

Preparatory brands affected include Victoza, Ozempic, Rybelsus and Trulicity.

New guidance from the two groups aimed at prescribers, commissioners and patients aims to support clinicians in selecting alternative glucose-lowering therapies when GLP-1 RAs for type 2 diabetes are unavailable.

The use of GLP-1 RAs in managing obesity is outside the guidance scope, which also warns patients with type 2 diabetes about the risk of obtaining counterfeit medicines without a legal prescription.

Advice from the Department of Health and Social Care (DHSC), which applies until the supply issues have been resolved, says that GLP-1 RAs should only be prescribed for their licensed indication, patients with type 2 diabetes should not be initiated on GLP-1 RAs for the duration of the national shortages, and prescribers should avoid switching between brands of GLP-1 RAs, including between injectable and oral forms.

Where a higher-dose preparation of GLP-1 RA is not available, it should not be substituted by doubling up a lower-dose preparation, says the DHSC. Where there is reduced access to GLP-1 RAs, support should be provided for people with type 2 diabetes to access weight management programmes where available.