Roles for the whole range of new type-2 diabetes drugs, including DPP-4 inhibitors and exenatide, have been set out in new NICE type-2 diabetes guidelines.
Sitagliptin and vildagliptin have been recommended as alternatives to a sulfonylurea.
The DPP-4 inhibitors should be considered in patients taking metformin who are unsuitable for treatment with a sulfonyl-urea, the guidelines say.
NICE also suggests that exenatide should be restricted to use in severely obese patients. The GLP-1 mimetic should only be used for patients with BMIs over 35 who have problems associated with their weight and need to improve their diabetes control, NICE says.
The guidelines recommend the use of pioglitazone or rosiglitazone as second- or third-line treatments and consider the place of long-acting insulin analogues in diabetes treatment.
GP Dr Brian Karet, diabetes lead for Bradford PCT, said the new guidance was to be welcomed. 'The new guidelines have brought things up to date,' he said.
'The previous guidance did not include any discussion of sitagliptin or vildagliptin and did not have much of a look at exenatide. So the new guidelines have set a line in the sand of where treatment currently stands.'
However, he pointed out that new drugs expected to be launched in the coming months could make this guidance out of date before the year is out.
Dr Karet said he was also pleased that the guidance has stressed treatments for use as alternatives to sulfonylureas.
'They are good at getting high blood sugars down, but they do not offer the same level of beta cell protection as metformin or thiazolidinediones,' he said.
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