Three new treatments for diabetes recommended by NICE

BMJ 2016; 353 doi: (Published 25 May 2016) Cite this as: BMJ 2016;353:i2980
  1. Ingrid Torjesen
  1. London

The National Institute for Health and Care Excellence (NICE) has published final guidance recommending three drugs—canagliflozin (Invokana), dapagliflozin (Forxiga), and empagliflozin (Jardiance)—as treatment options for adults with type 2 diabetes if metformin, sulfonylurea, or pioglitazone are contraindicated or not tolerated.1

The three drugs could be used as monotherapy in England and Wales if diet and exercise alone wasn’t controlling blood glucose level and a dipeptidyl peptidase 4 inhibitor would otherwise be prescribed.

Canagliflozin, dapagliflozin, and empagliflozin were selective sodium-glucose cotransporter 2 (SGLT-2) inhibitors that blocked the reabsorption of glucose in the kidneys and promoted excretion of excess glucose in the urine, and could help control glycaemia independently of insulin pathways.

Around three million people in the UK had type 2 diabetes and an estimated 31 000 people could be eligible for the three treatments, which cost around £475 (€622; $693) a year.

Carole Longson, director of the NICE centre for health technology evaluation, said, “For many people whose blood glucose levels aren’t controlled by diet and exercise alone, metformin is the first drug treatment that they’ll be offered. But some people may experience nausea and diarrhoea, and they may not be able to take it if they have kidney damage. For people who can’t take a sulfonylurea or pioglitazone, then the three drugs recommended in this guidance can be considered. This is as an alternative to the separate group of drugs called dipeptidyl peptidase-4 inhibitors.”


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