The National Institute for Health and Care Excellence (NICE) is recommending the use of one of three drugs in a newer class of type 2 diabetes treatments if standard treatment is not suitable. The news comes on the heels of an announcement by the European drug regulator that it was conducting a safety review of one of the medications due to an increased risk of lower limb amputations and new warnings by the U.S. drug regulator for an increased risk of a serious condition called ketoacidosis.
NICE is part of the UK’s Department of Health serving both the English National Health Service and the Welsh National Health Service. In a statement, Professor Carle Longson, director of the NICE Centre for Health Technology Evaluation, said, “For many people whose blood glucose levels aren’t controlled by diet and exercise alone, metformin is the first drug treatment that they’ll be offered. But some people may experience nausea and diarrhea, and they may not be able to take it if they have kidney damage. For people who can’t take a sulfonylurea or pioglitazone, then the three drugs recommended in this guidance can be recommended.”
The three diabetes drugs being recommended are Invokana (canagliflozin), Foxiga (dapagliflozin) and Jardiance (empagliflozin). They belong to a class of drugs known as sodium glucose co-transporter (SGLT2) inhibitors. They work by blocking the reabsorption of glucose in the kidneys and the elimination of excess glucose from the body in the urine. These drugs were previously considered for the UK National Health Service use in combination with other diabetes treatments rather than mono-therapies.
SGLT2 inhibitors have been linked to serious urinary tract infections as well as ketoacidosis, a condition in which too much acid builds up in the blood. The SGLT2 inhibitor Invokana is also under investigation by the European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA) for an increased risk of lower limb amputations, in particular toe amputations.