6.1.2.6 GLP-1 mimetic (injectable)

ChoiceDrugDosage
1st choice Liraglutide injection 6mg/ml

Dose:
Initially 0.6mg once daily, increased after at least 1 week to 1.2mg once daily
Renal impairment – see BNF

2nd choice
(where weekly injection is preferred)

Dulaglutide 1.5mg/0.5ml, 3mg/0.5ml, 4.5mg/0.5ml solution for injectionDose:
Add-on therapy: 1.5 mg once weekly; increased if necessary to 3 mg once weekly after at least 4 weeks, then increased if necessary to 4.5 mg once weekly after another 4 weeks, a starting dose of 0.75 mg once weekly may be considered for potentially vulnerable patients; maximum 4.5 mg per week.

Renal impairment – see BNF

Prescribing Notes

  • Prescribe as per NICE Guideline NG28 recommendations. See also NICE visual summary for blood glucose lowering therapy in adults with type 2 diabetes.
  • To prevent waste, please avoid prescribing large quantities – GLP-1 mimetics require refrigeration and are expensive. One month’s supply should be adequate for most patients.
  • Stopping rules with GLP-1 mimetics: NICE state only continue GLP‑1 mimetic therapy if the person with type 2 diabetes has had a beneficial metabolic response (a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body weight in 6 months).
  • Gastric emptying may be delayed. Therefore the rate and extent of absorption of other oral drugs administered at the same time may be affected.
  • Doses of concomitant sulfonylurea may need to be reduced when a GLP-1 mimetic is started.
  • Upper gastrointestinal side effects such as nausea are common with GLP-1 mimetic therapy.
  • There are rare reports of acute pancreatitis in patients using these drugs. GLP-1 mimetics should be avoided in patients considered to be at high risk of pancreatitis. Patients and their carers should be told how to recognise signs and symptoms of pancreatitis.
  • Thyroid adverse events, including increased blood calcitonin, goitre and thyroid neoplasm, have been rarely reported in clinical trials with liraglutide, particularly in patients with pre-existing thyroid disease.

 Cautions

  • Diabetic ketoacidosis has been reported in patients with type 2 diabetes on a combination of a GLP-1 receptor antagonist and insulin who had doses of concomitant insulin rapidly reduced or discontinued. See MHRA for further details