diabetesMore than 220,000 adults diagnosed with type 2 diabetes in Scotland, will now also be able to access dapagliflozin through NHS Scotland as part of a triple therapy regimen with metformin and sulphonylurea.

Approval for AstraZeneca’s first-in-class sodium-glucose co-transporter 2 (SGLT2) inhibitor for type 2 diabetes, known commercially as Forxiga was granted by the Scottish Medicines Consortium (SMC) this week [7 Aug].

It can now be prescribed within restricted use as an alternative to dipeptidyl peptidase-4 (DPP-4) inhibitors. Triple therapy can be prescribed to improve glycaemic control with metformin and sulphonylurea, when these, together with diet and exercise, do not provide adequate blood glucose control.

Dr Kevin Fernando, GP Partner at North Berwick Health Centre, said: "For many patients whose blood sugar is no longer adequately controlled with metformin and sulphonylurea, adding another oral therapy such as dapagliflozin or a DPP-4 is preferable to starting injectable treatment.

"In my clinical experience, I have found that dapagliflozin offers a good alternative to DPP-4s, as it can help patients reach their blood glucose targets while also providing a significant secondary weight loss benefit. Today’s announcement by the SMC means that more patients will have access to this treatment option through NHS Scotland."

Further reading: Diabetes - reducing the burden

As well as providing an alternative treatment for patients in Scotland on metformin and sulphonylurea, unlike other classes of oral diabetes medicines, including DPP-4 inhibitors, SGLT2 inhibitors like dapagliflozin also offer an additional benefit of weight loss.

This is particularly important as 80-85% of people with type 2 diabetes are overweight, increasing their risk of developing cardiovascular complications.

There are an estimated 221,500 people with diagnosed type 2 diabetes in Scotland and possibly a further 43,000 undiagnosed. In Scotland alone it is anticipated that approximately 16,800 new cases of type 2 diabetes are diagnosed each year.

Dapagliflozin is administered as one 10mg tablet once daily and can be taken at any time of day, with or without food and no requirement for titration,4,# providing a simple treatment regimen, which in turn is likely to support good adherence.

"Over 66,000 prescriptions have been written for dapagliflozin since it was launched in the UK last year and this latest decision by the SMC means that more patients will be able to access it through NHS Scotland,” said Lisa Anson, President AstraZeneca UK and Ireland.

"Dapagliflozin is the only SGLT2 inhibitor that has this level of real-world patient experience in the UK, as well as clinical data showing significant reductions in blood sugar, weight and rates of hypoglycaemia over four years."