What proportion of patients fail NICE criteria for continuing GLP-1 treatment beyond six months, and why?

Glucagon-like peptide 1 (GLP-1) agonist treatment in type 2 diabetes typically improves glycaemic control and results in weight loss. The National Institute for Health and Clinical Excellence (NICE) continuation criteria are that at six months patients must have achieved at least a 3% reduction in weight and an 11 mmol/mol (1 %) reduction in HbAic. The St Helens Hospital diabetes team has provided a GLP-1 service since 2007. As from August 2010, we implemented a new service structure to intensify support to patients, including monthly follow up for the first six months. We assessed NICE continuation criteria in 43 patients who attended since the change in service structure, met NICE initiation criteria and received at least six months' treatment. Mean age was 56 years (SD 10), diabetes duration 10 years (SD 5), baseline median weight 118kg (range 78-152), BMI 41 kg/m2 (range 31-60), and HbAic 83mmol/mol (range 63-120; DCCT: 9.7% [7.9-13.1]). Thirty (70%) patients met continuation criteria. After follow up of a median 8 months (range 6-12), these patients had a median weight loss of 7.8kg (range 3-21) and a median HbAic fall of 24.2mmol/mol (range 11-34; DCCT: 2.2% [1-5.3]). Of those failing NICE continuation criteria, 38.5% failed on weight alone, 38.5% on HbAic alone, and 23% on both. Baseline characteristics could not predict treatment failure. Median weight loss in those failing on HbAic alone was 8.7kg (range 2.4-12.4). Median reduction in HbAic in those failing on weight alone was 29.7mmol/mol (2.7%). We conclude that in our clinic most patients can continue GLP-1 treatment, but approximately 30% fail to meet NICE continuation criteria, despite clear treatment benefits. Copyright (C) 2013 John Wiley & Sons.