Guidance for type 2 diabetes medicines updated by NICE

Recommendations made on medicines to treat type 2 diabetes as part of revisions by the National Institute for Health and Care Excellence (NICE).

Four technology appraisals for type 2 diabetes have been updated, and guidance on a further four medicines is being withdrawn, as part of NICE's first test of a new way of keeping all its guidance aligned.

The changes follow recent updates to the NICE guideline on type 2 diabetes in adults. The revised guidelines highlighted that several existing technology appraisals (TAs) for diabetes medicines had fallen out of step with the new recommendations.

The guideline covers care and management for adults (aged 18 and over) with type 2 diabetes. It focuses on education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications.

Going forward NICE suggests faster alignment of technology appraisals will be possible with clinical guidelines trialled in the type 2 diabetes update.

NICE tested a new process as part of its whole lifecycle approach programme. 

A panel including the chair and vice chair of technology appraisal committee B, and the chair and vice chair of the guideline committee, was asked if it was appropriate to update the affected appraisals and align them with the guideline.

This allowed the TAs to be updated based on the evidence reviewed in the guideline, rather than requiring a new evidence submission for each appraisal.

TA guidance on tirzepatide, ertugliflozin, empagliflozin and canagliflozin has been updated as a result, to bring it into line with the recommendations already made in NICE's guideline on type 2 diabetes in adults.

The recommendations for medicines under patent continue to be supported by a funding mandate. This supports adoption and uptake of the recommendations.

Separately, four appraisals covering specific uses of dapagliflozin and other SGLT-2 inhibitors are being withdrawn.

NICE does not consider it appropriate to routinely update TAs for medicines that are no longer under patent, such as dapagliflozin, and use of dapagliflozin is now covered by class-level recommendation of SGLT-2 inhibitors in the guideline.

The guideline recommends use of the least expensive suitable SGLT-2 inhibitor, considering administration costs, dosages, price per dose and commercial arrangements.

NICE said the withdrawal of the TAs for dapagliflozin is not expected to impact patient and clinician choice. As dapagliflozin is now off-patent, it is likely to be the least expensive option in many cases, but the guideline does not name a single preferred medicine.