The National Institute of Health and Clinical Excellence has published new guidance for the month of October 2010. This month there is one clinical guideline and one technology appraisal that impact upon primary care.
The technology appraisal (QRG) reviews the place for liraglutide (Victoza®) in the treatment of type 2 diabetes mellitus. It is recommended as an alternative to exenatide (Byetta®) in the following circumstances:
- At a maximum dose of 1.2mg daily (1.8mg daily is not recommended)
- In triple therapy combination with metformin and a sulphonylurea or a glitazone
- In dual therapy combination with metformin or a sulphonylurea when other oral treatments (including metformin, sulphonylureas, glitazones and gliptins) are not tolerated or contraindicated
- Control of blood glucose remains or becomes inadequate (HbA1c above 7.5% or other higher level agreed with the individual)
- BMI > 35kg/m2 and associated weight based medical problems or BMI < 35kg/m2 where weight loss would benefit co-morbidities, or insulin therapy would have significant occupational implications
- Treatment should only be continued if successful in reducing HbA1c by 1% at 6 months and body weight by 3% in the same time period when use in triple therapy
Action: Clinicians should be aware of these recommendations and implement any necessary changes to practice.