Type 2 diabetes: part two

Likelihood of benefit 

There comes a time in the management of long-term conditions when the benefits
are made irrelevant by reduced life expectancy resulting from the condition itself or because
of another condition. A medicine that increases five-year survival may not be necessary in a patient who may not survive the next year, and such considerations should be reviewed.

Licensed combinations 

There are already a number of medicines within each class, and more coming to the market. The DPP-4 inhibitors currently include alogliptin (Vipidia), linagliptin (Trajenta), saxagliptin (Onglyza), sitagliptin (Januvia) and vildagliptin (Galvus). 

Diabetes is one of the few conditions where medicines within each therapeutic group have different licences. For example, linagliptin (Trajenta) is not currently licensed for use in combination with a sulfonylurea unless it is part of triple therapy that also includes metformin. However, sitagliptin (Januvia) can be combined with a sulfonylurea whether or not metformin is used. Licences can change – stay up to date using the medicine’s current SPC.

Cost 

Once everything else has been reviewed, the final consideration is cost. To some extent, cost effectiveness has already been taken into account within the NICE guidelines, but there may be small savings to be made at a local level by careful selection of one medicine over another. 

Practice point

Find out how the NICE guideline has been interpreted in your area by looking at local formularies, guidelines and shared care arrangements for type 2 diabetes.