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Our response to serious supply problems with medicines for people with type 2 diabetes

The NHS continues to struggle with supply problems for glucagon-like peptide receptor agonists (GLP-1 RAs or GLP-1 analogues), a range of drugs used to regulate blood sugar levels in people with type 2 diabetes.

The global supply shortage is partly due to a surge in off-label prescriptions of the weight-loss drug semaglutide, which exceeds supply.

Previously (since summer 2023), all stocks of GLP-1 RAs had to be reserved for those already using these drugs, meaning thousands of people who could benefit from these drugs did not have access to them.

Earlier this year we were pleased to see that supplies of Rybelsus were increasing so that people could now start taking a GLP-1 medicine. And another medicine called Mounjaro is now available across the UK as a treatment for people with type 2 diabetes.

We remain concerned about the disrupted supply and ongoing shortages of GLP-1 medicines, which have serious consequences for many people with type 2 diabetes.

The bottlenecks are expected to ease by the end of 2024 and in 2025.

What’s new regarding the deficiency of GLP-1 RAs?

Some GLP-1 agonists, including Ozempic (injectable semaglutide), are still experiencing supply shortages and some of these drugs may not be available until 2025. However, Rybelsus (oral semaglutide) and Mounjaro (tirzepatide) are now well supplied.

From March 2024, people in England, Scotland and Northern Ireland with type 2 diabetes can be offered Mounjaro if they do not have access to Ozempic, Trulicity or other GLP-1 medicines.

Concerns remain that off-label prescribing of GLP-1 will exacerbate shortages, and the Department of Health and Social Care and NHS England believe that these drugs should not be prescribed without a license.

In June 2024, the World Health Organization (WHO) issued a warning about counterfeit versions of semaglutide identified in the UK. The WHO has advised that treatment with semaglutide should only be carried out by a doctor and that semaglutide should not be purchased online.

What are the latest guidelines?

A January 2024 National Patient Safety Alert and a March 2024 Medicines Safety Communication outlined a series of measures that physicians should follow until shortages are resolved, including prescribing GLP-1 RAs only for their approved indication.

Clinicians are also encouraged to proactively engage with individuals already taking GLP-1 RAs who are affected by the shortages and consider prioritising them for review based on the criteria set out in the clinical guidelines and:

  • Discuss discontinuation of GLP-1 RA if treatment goals are not met
  • Avoid duplicating a lower dose preparation if a higher dose preparation of a GLP-1 RA is not available
  • Do not switch between strengths of a GLP-1 RA based solely on availability
  • Do not prescribe more than one month's supply unless there is a good reason to do so.

If someone is prescribed Victoza, or if a diabetic cannot receive Ozempic or Trulicity for two weeks or more, prescribing physicians should:

  • Consider prescribing Rybelsus tablets or Mounjaro KwikPens and ensure that the diabetic patient receives appropriate needles.
  • When prescribing Mounjaro or Rybelsus, make sure that the person with diabetes does not have intolerance to the drug
  • If the above options are not considered appropriate, or if primary care prescribers require further clinical advice, they should consult specialists regarding treatment options.

The Primary Care Diabetes Society (PCDS) and the Association of British Clinical Diabetologists (ABCD) issued guidance in 2023 which also recommends supporting eligible people to access weight management and remission services. They have issued further guidance on prescribing Mounjaro.

Which medicines are affected by the shortage?

Current shortages affect the supply of most GLP-1 RA drugs, including Ozempic, Trulicity, Victoza and Saxenda.

A limited supply of Wegovy and Saxenda is also available through specialist weight management services, but only to people with type 2 diabetes who meet the criteria.

Is it the same throughout UNITED KINGDOM?

The shortages are having a global impact, including in the UK. Scotland, Northern Ireland and Wales have all issued guidance that mirrors that of the Department of Health and Social Care.

What does Diabetes UK do?

We support the guidance and have ongoing discussions with manufacturers and the Department of Health and Social Care about our concerns about the impact on people with diabetes and how the situation could be improved.

Douglas Twenefour, Head of Care at Diabetes UK, said:

“The ongoing shortages of some GLP-1 medicines are having serious consequences for many people with type 2 diabetes and remain a major problem. With these shortages likely to continue for at least the rest of the year, this will have a significant impact on whether many people with type 2 diabetes can access the best treatment for them.

“We fully support the guidance that GLP-1 drugs should not be prescribed outside of their approved range under any circumstances as long as there is an ongoing shortage affecting people with type 2 diabetes.

“We welcome the increased supply of Rybelsus and the launch of Mounjaro announced earlier this year. This will give people with type 2 diabetes who meet the criteria the opportunity to start taking a GLP-1 medicine.

“Anyone affected by these shortages should be contacted by their healthcare team to discuss the best course of treatment available, but if you are still concerned you can call the Diabetes UK helpline on 0345 123 2399.”

What should you do if your prescription is affected?

We recommend that you contact your healthcare team if you are affected by shortages of GLP-1 analogues. These shortages mean that some people may need to switch to a different medication or treatment plan. Your healthcare team should be able to discuss the options with you.

Lower doses of GLP-1 should not be doubled as this would result in a shortage of the drug. GLP-1 RAs should only be obtained by prescription from registered pharmacies and should not be purchased online without a prescription. It is not legal to obtain a GLP-1 RA without a prescription and there is a risk that the drug may not be what it claims to be.

You may be offered a diabetes assessment before your next scheduled appointment. If your medication changes and you need support, ask your healthcare team about structured education and whether a referral to a diabetes remission or weight management program might be right for you.

If this deficiency is affecting your mental health and wellbeing, you can call the Diabetes UK helpline – 0345 123 2399.

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