Important issues for pharmacy teams

People currently taking standard-release metformin without any problems do not need to be switched to metformin MR. However, those intolerant of standard-release metformin or with preference for metformin MR should be supported to switch. 

The current underutilisation of SGLT-2 inhibitors and the potential to reduce health inequalities with increased prescribing and uptake has been highlighted by NICE. As noted earlier in this module, SGLT-2 inhibitors are proven to reduce glucose levels as well as protect the heart and kidneys thereby preventing or reducing cardiorenal complications.

Pharmacy teams should actively identify people who could benefit from the addition of an SGLT-2 inhibitor to their treatment.

The move to make SGLT-2 inhibitors first-line therapy alongside metformin MR for almost all newly diagnosed adults will substantially increase their use in primary care. New medicine service (NMS) consultations will now frequently involve two medicines from week one, and people should be provided with clear advice explaining the benefits of starting dual therapy earlier.

According to NICE, achieving a 90% uptake of the new joint first‑line treatment with SGLT-2 inhibitors and metformin could prevent up to 22,000 deaths each year.

Similarly, recommending GLP-1 receptor agonists as part of initial treatment for those diagnosed with type 2 diabetes before the age of 40 will increase costs. However, the potential for weight loss due to the earlier intervention could reduce morbidity and associated long-term treatment costs.

Therefore, the cardiovascular and renal benefits from increased use of SGLT-2 inhibitors and GLP-1 receptor agonists, where applicable, should reduce the overall long-term costs of managing diabetes complications.