The NHS continues to face supply issues with glucagon-like peptide receptor agonists (GLP-1 RAs, or GLP-1 analogues), a range of drugs used for managing blood glucose levels in people with type 2 diabetes.
The global shortage in supply was partly due to a surge in off-label prescriptions of the drug semaglutide being issued for weight loss, which was exceeding supply.
Previously (since the summer of 2023) all stocks of GLP-1 RAs had to be reserved for those already using these medications, meaning that thousands of people who could benefit from these medications were not able to access them.
In the second half of 2024, we were pleased to see an increase in supply of Rybelsus, which meant that people could be newly initiated on a GLP-1 medication. And another drug called Mounjaro has since become available as a treatment for people with type 2 diabetes across the UK.
We remain concerned about the intermittent supply and ongoing shortages of GLP-1 medications which are having implications for many people with type 2 diabetes.
Shortages are expected to ease by the end of 2024 going into 2025.
What's the latest with the shortage of GLP-1 RAs?
There is still intermittent supply and shortages of some GLP-1 agonists including Ozempic, (injectable semaglutide), which are expected to be resolved by the end of December 2024, with Victoza shortages expected to be resolved in January 2025. But there is now good supply of Rybelsus (oral semaglutide) and Mounjaro (tirzepatide).
Since March 2024, people in England and Northern Ireland living with type 2 diabetes can be offered Mounjaro if they are unable to access Ozempic, Trulicity or other GLP-1 medications. Recently, this also became available in Scotland.
There is still concern that off-label prescribing of GLP-1s could worsen the shortages and the Department for Health and Social Care and NHS England says that all these medications should not be prescribed off-licence.
In June 2024, the World Health Organisation (WHO) issued a warning over fake versions of semaglutide which have been identified in the UK. The WHO has advised that semaglutide treatment should only come through a healthcare professional, and that semaglutide should not be bought online.
What is the latest guidance?
Guidance in a National Patient Safety Alert in January 2024 and a Medicines Safety Notice in March 2024 outlined a set of actions for clinicians to follow until the shortages are resolved. These included only prescribing GLP-1 RAs for their licensed indication.
Clinicians were also encouraged to proactively engage with people established on GLP-1 RAs who are impacted by the shortages, and consider prioritising them for review based on the criteria set out in clinical guidance, and:
- Discuss stopping the GLP-1 RA if treatment goals have not been achieved
- Avoid doubling up a lower dose preparation where a higher dose preparation of a GLP-1 RA is not available
- Do not switch between strengths of a GLP-1 RA solely based on availability
- Do not prescribe more than one month’s supply unless there is clear reason to do so.
Where someone is prescribed Victoza, or where someone with diabetes is unable to obtain Ozempic or Trulicity for two weeks or more, prescribers should:
- Consider prescribing either Rybelsus tablets or Mounjaro KwikPens, and ensure the person with diabetes is prescribed appropriate needles
- If prescribing Mounjaro or Rybelsus, ensure that the person with diabetes is not intolerant to the medication
- If the above options are not considered appropriate, or if prescribers in primary care require further clinical advice, they should liaise with specialists on management options.
The Primary Care Diabetes Society (PCDS) and Association of British Clinical Diabetologists (ABCD) produced 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 drugs are impacted by the shortage?
The current shortages are impacting on supplies of most GLP-1 RA medications, including Ozempic, Trulicity, Victoza and Saxenda.
A limited amount of Wegovy and Saxenda is also available through specialist weight management services only for people with type 2 diabetes who meet the criteria.
Is it the same across the UK?
The shortages are having a global impact including across the UK. Scotland, Northern Ireland and Wales have all issued guidance which reflects that issued by the Department of Health and Social Care.
What are Diabetes UK doing?
We are supporting the guidance, and we have had ongoing discussions with manufacturers and the Department for Health and Social Care about our concerns over how this is impacting people with diabetes, and how the situation might be improved.
Douglas Twenefour, Head of Care at Diabetes UK, said:
“The ongoing shortages of some GLP-1 medications are having serious implications for many people with type 2 diabetes. With these shortages likely to last, this could have a significant impact on whether some people living with type 2 diabetes can access the best course of treatment for them.
“We fully support the instruction that GLP-1 medications should not be prescribed off-label under any circumstances while there is an ongoing shortage impacting people with type 2 diabetes.
"We welcome the increased supply of Rybelsus and the introduction of Mounjaro – which offers the chance for people with type 2 diabetes who meet the criteria to be started on a GLP-1 medication.
"Anyone affected by these shortages should be contacted by their healthcare team to discuss finding the best course of treatment available. But if you are still concerned, you can ring the Diabetes UK helpline on 0345 123 2399.”
What to do if this affects your prescription
We advise that you contact your healthcare team if you’re affected by shortages of GLP-1 analogues. These shortages mean that some people may need to change to a different medication or management plan. Your healthcare team should be able to discuss the options with you.
Lower doses of GLP-1 should not be doubled up and GLP-1 RAs should only be obtained on prescription from registered pharmacies and not be bought online without a prescription. It is not legal to obtain a GLP-1 RA without a prescription and there is a risk that the medicine may not be what it says it is.
If your medication changes and you need support, ask your healthcare team about structured education and whether a referral to diabetes remission or weight management programme might be suitable for you.
If this shortage is impacting on your mental health and wellbeing you can call the Diabetes UK Helpline – call 0345 123 2399.
