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August 2019

NICE approves first SGLT2 inhibitor for type 1 diabetes



NICE has approved the SGLT2 inhibitor, dapagliflozin, as add-on therapy to insulin for people with type 1 diabetes (T1D) when insulin alone does not provide adequate glycaemic control.

The oral medication is only recommended at a dose of 5mg once daily for adults with T1D and a body mass index of at least 27kg/m2, if:

  • They are on insulin doses of more than 0.5 units/kg of body weight/day, and
  • They have completed a structured education programme that includes information about the risk of diabetic ketoacidosis (DKA); how to recognise DKA and its signs and symptoms; how and when to monitor blood ketone levels; what actions to take if they are elevated, and
  • Treatment is started and supervised in a hospital diabetes clinic.

NICE also recommends that HbA1c levels are assessed after 6 months and regularly thereafter and to discontinue dapagliflozin if there has not been a sustained improvement in glycaemic control.

Approximately 90,000 people in England alone could be eligible for treatment with this regime.

Parth Narendran, Reader in Diabetes Medicine and Honorary Consultant Physician at University Hospital Birmingham, UK, said: ‘This is an exciting milestone for people with type 1 diabetes, addressing a significant unmet need. This patient population requires lifelong insulin therapy, yet many have difficulty achieving recommended blood glucose levels with insulin alone.’