NICE recommends tirzepatide (mounjaro) for T2 diabetes

[everydayupsanddowns]

National Institute for Health and Care Excellence (NICE) is publishing draft guidance today, approving the use of tirzepatide (brand name Mounjaro) for treating type 2 diabetes in England and Wales.

Evidence from clinical trials showed using tirzepatide resulted in significant reductions in blood sugar levels and body weight compared with semaglutide, insulin therapy or a placebo. The evidence showed using tirzepatide resulted in 81% to 97% of people reaching better glucose control and 54% to 88% reaching a 5% or greater reduction in body weight, which were significantly more than any of the comparators.

Douglas Twenefour, Head of Care at Diabetes UK, said: “We welcome NICE’s decision to approve tirzepatide (Mounjaro) to be prescribed on the NHS as this will provide another effective treatment option for managing type 2 diabetes. It is very promising that the trial data showed great improvements in blood glucose management and weight loss.

“The current GLP-1 medication shortages are causing stress and uncertainty for many people with type 2 diabetes. Whilst the approval of tirzepatide is welcome, we are calling for more action to ensure ongoing and sufficient supply of these medications to people with type 2 diabetes.”

Final guidance is scheduled to be published on 11 October 2023. Once final guidance is published the product will be made available in the NHS within 90 days dependent on the supply of licensed product by the manufacturer.

Tirzepatide is injected weekly by the patient.

It is licensed to treat adults who are finding it difficult to manage their type 2 diabetes alongside diet and exercise when metformin (the main first line medicine for type 2 diabetes) cannot be tolerated. In its submission to NICE the company positioned it as an option for a narrower population - adults with type 2 diabetes who are not achieving recommended glucose outcomes with 3 or more antidiabetic drugs. This makes it an alternative to similar treatments such as dulaglutide, liraglutide and semaglutide (ozempic/rybelsus) which are already recommended for use in the NHS.

 

[Martin.A]

I read an article about this earlier. I was surprised to learn that two in three people with Type 2 don't have it under control, according to Nice.

 

[everydayupsanddowns]

I read an article about this earlier. I was surprised to learn that two in three people with Type 2 don't have it under control, according to Nice.

Yes it’s a pretty stark statistic isn’t it - and goes to show how difficult T2 diabetes can be to manage well, and how well comparatively forum members generally do.

Peer support and shared experiences can really help people optimise their self management strategies.

 

[harbottle]

I read an article about this earlier. I was surprised to learn that two in three people with Type 2 don't have it under control, according to Nice.

I am not surprised at all.

I know a few people with T2, and not many of them have made the relevant lifestyle changes to try to get it under control.

A lot of people seem to just ignore it.

 

[AndBreathe]

I am not at all surprised that 2 out of 3 people living with T2 are not under control. Whilst they are being told to eat plenty "healthy" carbs, I think it amazing to think that 1 in 3 are under control.

I feel very conflicted about the approvals of these drugs, because why would patients want to bother to do the hard yards themselves? With these drugs, those GP DSNs stating patients will be on meds for life will see their prophesies come true.

Surely this can't be saving the NHS any money?

Just when the concept of remission was catching on, it'll be flushed out of fashion by the new "wonder drug".

Please don't think that I want to help people being diagnosed with T2, but heck.

 

[rebrascora]

I am not at all surprised that 2 out of 3 people living with T2 are not under control. Whilst they are being told to eat plenty "healthy" carbs, I think it amazing to think that 1 in 3 are under control.

I feel very conflicted about the approvals of these drugs, because why would patients want to bother to do the hard yards themselves? With these drugs, those GP DSNs stating patients will be on meds for life will see their prophesies come true.

Surely this can't be saving the NHS any money?

Just when the concept of remission was catching on, it'll be flushed out of fashion by the new "wonder drug".

Please don't think that I want to help people being diagnosed with T2, but heck.

Must admit, I have very similar thoughts. If people were supported to test and make the appropriate dietary/lifestyle changes in the first place then much fewer of these drugs would be needed. If you offer people a sliver bullet straight off they will jump at the chance.... look at the mayhem caused my people wanting Ozempic as a result of social media content.... even if it turns out to be silver plated and tarnished and slowly loses it's potency.
Our modern diet is killing us and people need to wise up and at least try the tougher route first and hopefully develop a healthier eating habit before being offered drugs, if necessary.

 

[helli]

Our modern diet is killing us

I am not sure what is a "modern diet".
My feeling is that it is the choices some people make (which are often the ones pushed through ads, etc) negatively impact their health. But only some people - people don't get type 2 diabetes just because they eat a lot of carbs. Two people could eat identical diets and live identical health styles but only one may get type 2.
I agree that extra drugs can make people believe they are in control and not do anything else. I see it clearly with my in-laws. It is a shame that doctors do less to promote the lifestyle that is beneficial based on our health conditions and just go for a blanket "lose weight".
This is something I experienced when I was first diagnosed with Type 1 with a BMI of 22. I was told to avoid fatty food because "people with diabetes" need to lose weight.

 

[MarinaDE]

I have a different view of these drugs, because I had a flatmate back in the 1990s who had a serious cigarette problem. I went with him to a hospital clinic and they told him his addiction was so bad they might have to admit him to hospital to cure it. (Cigarette addiction, like many things, lies on a spectrum, and they said anyone who wakes up in the night for a nicotine fix has an incredibly serious problem.) He tried everything to give up. Patches, gums, changing routines, not going out to socialise, and plenty of shaming from his doctor. In those days, the prescription was basically "willpower", and you were considered morally weak if you couldn't do it.

Then Zyban came out and he took it. In just two weeks, no more desire to smoke. One by one my friends did the same thing and stopped smoking. That was 20+ years ago, and they're all free of strokes, heart attacks, cancers, and all the other things that would have cost the health system a bomb.

If these new drugs can prevent decades of heart disease, cancer, you name it, then they will pay for themselves. The price will eventually have to drop as new drugs come online. From what I've read, they give people a mental break from unrelenting food noise, that means some people are just spending all their mental power thinking about food and how to avoid it. Once that's gone, it might be far, far easier to make a lifestyle change. They also seem to kill the desire for alcohol, which can only be a good thing.

 

[Martin.A]

Some people are just spending all their mental power thinking about food

That's me for sure. It's almost an obsession. The first thing I do in the morning (after testing) is open the spreadsheet I use as a food diary, which I update as the day goes on - what have I eaten, what to eat next, when to eat it, how much of it, with everything weighed out.

 

[AndBreathe]

I have a different view of these drugs, because I had a flatmate back in the 1990s who had a serious cigarette problem. I went with him to a hospital clinic and they told him his addiction was so bad they might have to admit him to hospital to cure it. (Cigarette addiction, like many things, lies on a spectrum, and they said anyone who wakes up in the night for a nicotine fix has an incredibly serious problem.) He tried everything to give up. Patches, gums, changing routines, not going out to socialise, and plenty of shaming from his doctor. In those days, the prescription was basically "willpower", and you were considered morally weak if you couldn't do it.

Then Zyban came out and he took it. In just two weeks, no more desire to smoke. One by one my friends did the same thing and stopped smoking. That was 20+ years ago, and they're all free of strokes, heart attacks, cancers, and all the other things that would have cost the health system a bomb.

If these new drugs can prevent decades of heart disease, cancer, you name it, then they will pay for themselves. The price will eventually have to drop as new drugs come online. From what I've read, they give people a mental break from unrelenting food noise, that means some people are just spending all their mental power thinking about food and how to avoid it. Once that's gone, it might be far, far easier to make a lifestyle change. They also seem to kill the desire for alcohol, which can only be a good thing.

I'm not saying there is no place for these drugs, but the inference in the media is everybody will just get it.

I know I have been incredibly fortunate to be able to shift my T2 into a much better place within 4 months of diagnosis, without any meds, and to remain there for almost 10 years. For a swathe of reasons, not everyone can do that, but the messaging is if Metformin doesn't work, you'll just be offered this new miracle. Let's face it, if you are aware that if the medication you are given "doesn't work", then you'll get the magic wand, why would you bother trying to work through the initial closeness with the loo and trying to adjust your lifestyle.

As far as giving folks more head space to make lifestyle changes? Why would they bother when they have the silver bullet already?

 

[AndBreathe]

That's me for sure. It's almost an obsession. The first thing I do in the morning (after testing) is open the spreadsheet I use as a food diary, which I update as the day goes on - what have I eaten, what to eat next, when to eat it, how much of it, with everything weighed out.

I'm sorry you find yourself in this situation. I'm not familar enough with your situation to comment further than to say if you are stable, is it worthwhile kepping doing what you have been doing for a few years, without the tethers to the spreadsheet?

 

[MarinaDE]

As far as giving folks more head space to make lifestyle changes? Why would they bother when they have the silver bullet already?

I guess that's a real possibility. I still think it's better for everybody if the consequences of poorly managed diabetes are avoided - fewer amputations, fewer strokes, less blindness, less cancer, heart disease etc. A magic bullet might equal moral hazard, but it's still less burden of disease down the road for the health care system to deal with.

 

[Martin.A]

is it worthwhile kepping doing what you have been doing for a few years, without the tethers to the spreadsheet?

Maybe, but it's the approach that got my HbA1c down from 114 to remission (under the previous definition) over 10 months and I'd like to think that I'm stable because I'm still doing it. I've worked in data analysis so using a spreadsheet is second nature.

 

[Martin.A]

I still think it's better for everybody if the consequences of poorly managed diabetes are avoided - fewer amputations, fewer strokes, less blindness, less cancer, heart disease etc.

It's the risk of complications that keeps me focussed on managing my T2. Maggie Davey's description 'blind amputee on dialysis dying from a heart attack or stroke' may be brutal but gets the message across. At a T2 Management presentation that I attended a GP presented a chart that showed that for patients with CVD who had at least one other medical condition, Diabetes was the top other condition.

 

[everydayupsanddowns]

I'm not saying there is no place for these drugs, but the inference in the media is everybody will just get it.

It’s a shame if it is being reported like that. The details from NICE and the drug manufacturer (Eli Lilly) is that this is:

an option for a narrower population - adults with type 2 diabetes who are not achieving recommended glucose outcomes with 3 or more antidiabetic drugs.

So it’s only intended for folk who have tried diet and exercise, and then moved through multiple different meds and are still finding it difficult to achieve the BG outcomes that are recommended.

 

[AndBreathe]

Maybe, but it's the approach that got my HbA1c down from 114 to remission (under the previous definition) over 10 months and I'd like to think that I'm stable because I'm still doing it. I've worked in data analysis so using a spreadsheet is second nature.

If it feeds your self declared obsession.......

 

[AndBreathe]

It’s a shame if it is being reported like that. The details from NICE and the drug manufacturer (Eli Lilly) is that this is:



So it’s only intended for folk who have tried diet and exercise, and then moved through multiple different meds and are still finding it difficult to achieve the BG outcomes that are recommended.

I agree, but it is how we see it, and I believe how it will be perceived by many patients. Nobody wants to have to change.

 

[Martin.A]

If it feeds your self declared obsession.......

I really don't understand why you felt you needed to post that.

 

[Eddy Edson]

I think some of the reactions to tirpezatide, semaglutide, the others further back in the pipeline, are fascinating. Just from the weight loss perspective, it's as if some people think *really* dealing with weight issues involves struggle against moral or cognitive flaws and these drugs are cheats which let you pretend to have dealt with these flaws while allowing them to continue to fester.

If you lose weight and keep it off without subscribing to some quasi-religious little food purity dogma - low carb, low fat, now low UPF - and making yourself a *better human being* you're cheating and your flaws will continue to poison your soul and psyche despite your artificially-skinny outer form. Or something.

It's just such crap. The huge demand for these drugs is driven mainly by the very large number of people who have struggled with weight forever, spent huge amounts of mental and emotional energy on trying every behavioural strategy and dogma for dealing with it, and not succeeded because their peptides are out of whack.

I'm coming up on five years of ~25% sustained body weight loss, via calorie coutning, simple mindfulness, frequent weighing and a bunch of exercise, and I have absolutely nothing to teach most of these people about anything. They've tried it all, and more, and worked harder at it than I've ever had to. The difference is I'm one of the minority of people who got lucky with their peptides etc, and they are not. Now they have medication options (modulo availability, and obviously modulo individual responsiveness and side-effects) to make up for that, and it's a great thing.

 

[Nayshiftin]

Yes it’s a pretty stark statistic isn’t it - and goes to show how difficult T2 diabetes can be to manage well, and how well comparatively forum members generally do.

Peer support and shared experiences can really help people optimise their self management strategies.

Its a bit like slimming clubs. When you go , you tend to stick on the diet and like . stop going n it piles back on. The forum is good support.
Also the support I’ve had these last few days no pill can achieve.
I wonder if Tiroerazide works with Jardiance snd can i self fund ? . one injection a week sounds good . Gp unlikely to fund.
Conversely I am doing good but cant promise ill stick to diet all the time.
But I am 100% in saying the forum has kept one husband with a wife. Keep up the good work.
if you can save one they say you save many.