Christine Jardine (Edinburgh West) (LD) I beg to move, That this
House has considered the availability of drugs to treat type 2
diabetes. It is a pleasure to serve under your chairmanship, Mr
Pritchard. I am grateful for the opportunity to speak about what is
a vital and, I think, under-recognised issue. I wish I did not have
to, and that all the necessary medicines were available for all of
the serious, life-changing conditions we face, but the reality at
the...Request free trial
(Edinburgh West) (LD)
I beg to move,
That this House has considered the availability of drugs to treat
type 2 diabetes.
It is a pleasure to serve under your chairmanship, Mr
Pritchard.
I am grateful for the opportunity to speak about what is a vital
and, I think, under-recognised issue. I wish I did not have to,
and that all the necessary medicines were available for all of
the serious, life-changing conditions we face, but the reality at
the moment is that they are not. Specifically, I would like to
talk about type 2 diabetes, which is more common than type 1 and
can go undiagnosed for years.
To be clear about what we are talking about, if someone’s body
does not make enough insulin or what it makes does not work
properly, the result is high blood sugar levels—type 2 diabetes.
If untreated, that increases the risks of serious problems with
their eyes, feet, heart and nervous system. High blood sugar
levels can cause serious complications, potentially at great cost
to individuals, but also to the national health service. The
reality is that any of us can develop type 2 diabetes, but it
mostly affects people over 25, and often those who have a family
history of it.
What about treatment and medication? We know there is currently
no cure, but we also know that type 2 diabetes can be put into
remission by losing weight. We all know that eating well and
exercising are the key to a healthy lifestyle, and that is never
truer than with preventing and reversing the onset of type 2
diabetes.
(Strangford) (DUP)
I commend the hon. Lady for bringing the debate forward. I am a
type 2 diabetic—I declare an interest as such—and when I was
diagnosed some 13 or 14 years ago, I went on a weight loss course
right away. The doctor told me, “You lose weight!” I lost about 4
stone, and I have kept it off, but that did not stop the diabetes
in its entirety. I still have it, and I still have to be very
careful about what I eat.
The point I want to make is that there are recent indications
that certain diabetes treatments can also be successful for
weight loss, but weight loss is really important at least for the
first stage of diabetes, and priority for such treatments must be
given to those with type 2 diabetes before, with respect, those
who are finding success with them for weight loss. How can the
Minister and our Government encourage such guidelines to be
firmly set in place?
I thank the hon. Member for that intervention, because that point
is at the heart of the matter. We have to ensure that the supply
of drugs, which is short at the moment, is prioritised for those
who need them for important health reasons.
A healthy weight, as the hon. Member said, and keeping active
make it easier for someone’s body to manage their blood sugar
levels and help prevent insulin resistance, which can lead to
type 2 diabetes. Research has shown that, for some people, a
combination of lifestyle changes can reduce the risk of type 2
diabetes by about 50%, but sufferers may also need to take
diabetes medication such as metformin and insulin, as well as
making changes to their lifestyle.
In the UK, 4.6 million people have type 2 diabetes and around
13.6 million are at risk of developing it. People often need
help, such as intervention and medicines. Last year, I called on
the UK Government to take action on the shortage of medicines for
type 2 diabetes patients, after a constituent came to me
concerned that her treatment and her health would be impacted by
a shortage of the diabetes drugs she needed. They are known as
GLP-1 RAs—glucagon-like peptide-1 receptor agonists—and include
one of the most common drugs, semaglutide.
As for many other manufactured drugs, there is currently a supply
problem with semaglutide. In this case, the problem has been made
worse, as the hon. Member for Strangford () said, by the fact that the same drugs are effective
for weight loss. The very thing that semaglutide does to help
diabetes patients is making it difficult for them to access
it.
I wrote to the Scottish Government, who told me they did not
expect the supply to return to normal until mid-way through this
year. I appreciate that that is not the most helpful response,
but in some ways it is understandable, because medicine supply
and licensing is a reserved matter. That is why I am raising it
with the UK Government. We have seen issues with drug shortages
beyond diabetes, and that is why I am so concerned at the slow
response to the lack of medication.
Patients find themselves stuck between the proverbial rock and a
hard place. In Scotland, they have the Scottish Government unable
to act, and they perceive the UK Government to be very slow to
act. It seems that neither Government have realised how
potentially serious this situation could be for patients who use
these drugs daily. For a patient to be in a position where they
do not know whether they can get what they need to help them get
well and keep them healthy is simply not acceptable. I have heard
from people in my constituency and beyond about the impact that
the situation is having on their lives.
(Wansbeck) (Lab)
Does the hon. Lady recognise that this is not just about access
to drugs for type 2 diabetics, but about access to medical
equipment, such as the LibreView glucose monitoring sensors that
have changed people’s lives? Does she agree that, because the
incidence of type 2 diabetes is closely related to areas of
social deprivation, where the finance is not available, the NHS
should look to give those sensors to as many people living with
type 2 diabetes as possible? That would save a fortune in the
future, and it would reduce harm to lots of people who are
currently suffering greatly because of diabetes.
The hon. Gentleman makes an excellent point, and I completely
agree.
Type 2 diabetes is a problem in itself, with the lack of
medication, but it is also an illustration of a major problem
that our health services are facing with growing costs. We should
be looking at how we prevent the problem in the first place, both
in areas of social deprivation and in society generally. We
should be looking at how we help people to avoid the problems
that come with conditions such as type 2 diabetes. If we fail in
that, people will fall into the situation where they are living
with diabetes—a condition that requires 24/7 self-management to
stay healthy. I invite Members to imagine living with a condition
that they have to manage every day—a condition that has the power
to affect them at any moment, disrupting what they are doing and
altering their day to day life—when they have done all they can
to stop that happening. Now consider how the lack of a medication
that we have organisations and administrations responsible for
providing makes that situation worse.
A couple of years ago, as part of a campaign by Diabetes UK, I
tried to live life as if I had diabetes, and I have to say that I
failed dismally. I realised just how difficult it is, and I
realised that people living with diabetes —type 1 or type
2—deserve much better than they are getting at the moment. To be
turned away at the GP surgery or pharmacy through no fault of the
practitioner and to be told, “You might have to wait 18 months
for what has been helping you get on top of the condition”, is
simply unacceptable.
I know some people who have been left waiting since 2023.
Shortages have been linked to those without diabetes using the
drugs, as the hon. Member for Strangford mentioned, simply for
weight-loss purposes. Drugs such as Ozempic are being sold online
for nearly £200—a 1,765% increase on the cost of what they would
be on an NHS prescription.
The Association of Independent Multiple Pharmacies has talked of
the shortage of medication to treat the likes of epilepsy and
attention deficit hyperactivity disorder as well as diabetes, all
of them potentially life-changing and life-ending conditions.
That is true also of some cancer drugs and hormone replacement
therapy. The consequences do not lie just at the door of patients
but, as we have heard, at that of the NHS and community pharmacy
teams, which are under increased strain.
A national patient safety alert has been issued by NHS England
and the Department of Health and Social Care to address supply,
but I ask those with the power to consider standing in the shoes
of those going through this. People who should have been started
on GLP-1s are facing delay or are being put on to less effective
options. Let us imagine being told that we had to take less
effective medicine for a life-changing condition. If the supply
is interrupted, a person potentially has to go through the side
effects again and again when being restarted. People have been
contacting Diabetes UK regularly since the start of the shortage
in early 2023. This is not just about equality or ease of access.
For all those affected, it is about quality of life.
4.12pm
The Minister for Health and Secondary Care ()
It is a pleasure to see you in the Chair, Mr Pritchard. I thank
the hon. Member for Edinburgh West () for raising such an
important issue. I want to begin by emphasising that I understand
that medicine supply issues are a significant cause of
frustration for many of our constituents across the United
Kingdom. I also recognise that there have been particular
challenges recently with certain medicines. Without diminishing
those challenges, it is important that we set them in
context.
There are around 1,400 medicines licensed in the UK, most of
which are in good supply. The Department is regularly notified of
supply issues; thankfully, the vast majority of those can be
managed with minimal impact on patients. The medicine supply
chain is highly regulated, complex and global, meaning that there
can sometimes be supply issues that affect the UK, along with
other countries around the world.
There are a number of reasons why a limited number of medicines
might be subject to a disruption in supply, such as manufacturing
difficulties, regulatory non-compliance, access to raw materials
or distribution problems. We cannot always prevent supply issues
occurring, but where they do the Department has a range of
well-established processes to manage them and help mitigate the
risk to patients.
Where there are concerns about supply, they largely, although not
exclusively, concern medication to treat the most common
conditions. That is exactly the case with what we are talking
about today—diabetes—a condition experienced by more than 4.9
million people across the UK. Action on diabetes will be included
in the major conditions strategy, as it is an important risk
factor for cardiovascular disease. If someone has diabetes, they
are twice as likely to have heart disease or a stroke than
someone who does not have diabetes, which goes to the heart of
what the hon. Member for Edinburgh West said about the importance
of ensuring diabetics get their medication.
I thank the Minister for his comprehensive and helpful response.
Some years ago, when I first came to Parliament there was a
diabetes strategy for the whole of the United Kingdom of Great
Britain and Northern Ireland. If the Minister could look at it, I
think a renewal of that particular strategy would help. It was
agreed here at Westminster, but took in all the regions of
Scotland, Wales and Northern Ireland. It was a marvellous
objective to address diabetes and it seemed to work. I would like
to see it happen again.
The hon. Member makes an important and powerful point, as usual.
As he knows, I am a proud Unionist and am keen for us to do as
much as we can in collaboration. I recognise that health is a
largely devolved matter. However, since I joined the Department
of Health and Social Care in October, I have visited Northern
Ireland, Scotland and Wales, I have talked about how we can
collaborate more closely on things such as research and
innovation, and I am sure that we can do more together where the
devolved Governments agree. Last night we had encouraging news.
Hopefully we will have power-sharing arrangements back in place
in Northern Ireland so that we can work together collaboratively
to deliver those benefits for patients.
I will finish the point I was making about the major conditions
strategy. That strategy aims primarily to improve care and health
outcomes for those living with multiple conditions, and it will
be centred on prevention. We have heard from a wide range of
stakeholders, whose views are informing the development of the
strategy. I will meet Diabetes UK this week to continue that
engagement.
With regards to the availability of drugs to treat type 2
diabetes, as the hon. Member for Edinburgh West set out, there
has been a significant global supply issue affecting
glucagon-like peptide-1 receptor agonists—GLP-1RAs—with the
shortages driven by an increase in demand for such products for
licensed and off-label indications, meaning that the medicine is
being used for a different use from that stated on its
licence.
I will set out the steps we have taken to manage those issues. We
have continued to work with suppliers to take action to resolve
the issues as quickly as possible, including expediting
deliveries and boosting supplies. In July last year, we issued
guidance for healthcare professionals, which took the form of a
national patient safety alert on how to manage patients during
the supply disruption. Clinicians and prescribers were directed
not to initiate new patients on these medicines, which were to be
used only to treat their licensed indication, protecting supplies
for diabetic patients. Guidance was supported and echoed in a
statement issued by the professional regulators.
One of the particular shortages affecting the market at the
moment is Ozempic, which is the brand name for semaglutide, which
is licensed to treat type 2 diabetes. Wegovy is the same
medicine—semaglutide—but licensed specifically for weight
management and is generally used at a higher dose than Ozempic.
Obesity-related conditions can be serious, so it is right that we
support people living with obesity to lose weight, and Wegovy is
one option for those with severe obesity and comorbidities.
However, it became available for prescription in the UK only on 4
September 2023, having received approval for use on the NHS for
weight management in March 2023.
We believe that supply issues with Ozempic have in part been
contributed to by off-label prescribing of that medicine for
weight loss ahead of Wegovy’s launch. However, the strong and
clear guidance that we provided on the use of those treatments
only for their licensed indications and our ongoing work with the
industry has helped to protect supplies for diabetic
patients.
As a result of our continued intensive work with the supply
chain, I am pleased to inform hon. Members that the supply
position of that particular drug has improved. Supplies of
Rybelsus have been boosted to support demand from new patients
with type 2 diabetes, patients switching from Byetta injections
and patients switching from Victoza injections. The national
patient safety alert was amended on 3 January to reflect that
positive development. The professional regulators have issued a
second statement to highlight that update.
I am also delighted to highlight the fact that the Medicines and
Healthcare Products Regulatory Agency gave regulatory approval in
the last few days to Mounjaro, an injectable medicine for adults
with type 2 diabetes. That will bring an additional treatment
option and will mean that more diabetic patients will have access
to the medicines that they need.
Sadly, supply is not expected to return to normal due to the
issues with certain products, but we will continue to work with
the manufacturers, the NHS, the MHRA and others working in the
supply chain, to help ensure that, overall, supplies of GLP-1 RAs
are available for patients.
I think the hon. Members for Edinburgh West () and for Wansbeck () and I would be interested know about the other
option—if I caught you right, Minister—that you mentioned, which
is in the form of an injection but is not insulin. Just so we
know, is it a different system?
Sorry, was the hon. Gentleman asking about the approval of the
new drug, Mounjaro, which I just mentioned?
Yes, I am trying to understand, because I am not aware of it, and
neither are the hon. Lady or the hon. Gentleman. It is not
insulin for type 2, is it? The Minister mentioned an injection
system.
It is an injectable medicine for adults with type 2 diabetes. It
was recently approved by the MHRA. To put a little bit of extra
information out there, the National Institute for Health and Care
Excellence recommended Mounjaro, the same drug, for the treatment
of patients with type 2 diabetes who meet specific criteria. The
NHS in England is therefore now legally required, in line with
NICE recommendations, to fund its use for eligible patients. The
availability of that new medicine in Scotland is, however, a
matter for the devolved Administration. The Scottish Medicines
Consortium, which makes decisions on the use of medicines in
Scotland, has not yet published guidance on Mounjaro. It will be
a matter for the SMC as to whether that becomes an option in
Scotland.
As I was saying, Mr Pritchard, unfortunately we expect supply
chain issues to continue for the rest of the year. Throughout the
management of this issue, our guidance has been supported by
additional advice issued in Scotland, Wales and Northern Ireland,
which has, critically, reinforced the messaging provided by the
national patient safety alerts.
Does the Minister understand and recognise the benefits of
glucose monitoring centres? It is not a supply chain issue, but
an access issue. They can and do change people’s lives, but they
are not widely accessible. People are very much unaware that they
actually exist. If they did and understood that the centres were
available from the NHS, it would save the NHS millions if not
billions of pounds. It would change the lives of many people,
mainly in deprived areas. Can the Minister give a commitment to
look at that and see how we can allow more people to access
glucose monitoring systems?
I hear what the hon. Gentleman says and I am more than happy to
look at the issue. However, I believe—I may be mistaken—that he
is suggesting something that we would routinely advise for type 1
diabetics to be provided to type 2 diabetics. As far as I am
aware, the clinical advice does not suggest that we do that, but
I am more than happy to look at the issue, because I want to
ensure that we support people living with diabetes as much as we
can.
Finally, I emphasise that our guidance remains clear that
medicines licensed for the treatment of type 2 diabetes should be
used only for that purpose. All prescribers, whether employed
privately or by the NHS, are expected to take into account the
appropriate national guidance. Unfortunately, the supply
disruption is a common issue for the UK and other countries
around the world, which is both frustrating and distressing for
patients. We cannot always prevent supply issues from occurring,
but where they do arise, the Department has a range of
well-established processes and tools to manage them and to help
mitigate the risk to patients. Addressing issues with GLP-1 RAs
continues to be a priority for the Department. We will continue
to work hard with industry to resolve the issues as quickly as
possible. Once again, I am grateful to the hon. Member for
Edinburgh West for raising such an important issue.
Question put and agree to.
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