Adapted from Pulse Feb 2021
NICE has approved Liraglutide for use in the NHS for weight loss. There are a list of requirements before it will be given though.
They also say that a calorie controlled diet and exercise will be necessary.
The person being considered for it must have a BMI of 35 or 32.5 for certain groups such as South Asians, Chinese, black African or African-Caribbean, who are at higher cardiovascular risk for any given BMI.
The person should have diagnosed pre-diabetes, equivalent to a HbA1c of 6.0 to 6.4% or a fasting blood sugar of 5.5 to 6.9.
They should also have a high risk of cardiovascular disease based on risk factors such has hypertension and lipid abnormalities.
Liraglutide will be provided by a specialist multi-disciplinary weight loss service.
The drug is a once weekly injectable. My comment: in my diabetic GP patients they found it easy to use and very effective for weight loss. It will be an alternative to other measures such as Orlistat and bariatric surgery.
A major problem is that the types of clinics that supply these services are over subscribed in the first place. From my own experience, many patients will meet the criteria, and many would welcome an opportunity to improve their health, appearance and sense of well being by this method. The clinics expect that patients will remain on the drug for two years. The problem is that to maintain the weight loss the drug may be needed lifelong. Currently the British Medical Association are against the introduction of the drug because they think that this will drive up the needs for blood test monitoring and referrals from GPs.
The original study was published in the New England Journal of Medicine by Wilding J et al in 2021. The mean bodyweight reduction was minus 14.9 % for the treatment group and just minus 2.4 % for the placebo group. Blood sugars and lipids improved considerably too. Nausea and diarrhea were the main side effects of the drug but these results tended to be mild and short lived.
In another study of the drug Semiglutide, by Davies M et al, published in the Lancet on March 2 2021, the importance of dose was assessed. They found that the higher dose had better effects on weight and blood sugar than the lower dose but also that the side effects were more frequent.