Diabetes medicines and monitoring
Disclaimer: The NHS West Yorkshire Integrated Care Board Diabetes Programme uses the medicines information resources below to support our organisation. We have not received sponsorship or paid for this information and sharing does not affiliate the West Yorkshire Health and Care Partnership to any pharmaceutical or other organisation.
Update 7 May 2025
The supply problem with GLP-1 receptor agonist (RA) medications used in the treatment of type 2 diabetes is now resolved. The supply for GLP-1 RA has largely improved with all strengths and presentations of semaglutide and dulaglutide now available. New biosimilar liraglutide preparations are going to become available shortly. For more information see: Prescribing GLP-1 receptor agonists – SPS - specialist pharmacy service – the first stop for professional medicines advice
Prescribers should consider prescribing GLP-1 RAs for patients within their licensed indications and in line with the relevant NICE guidelines.
Patients concerned about their current treatment, or who have questions about accessing these medicines, should contact their prescriber in the first instance
We are committed to enabling access to life changing technology for people living with diabetes who are eligible. We will work with people living with diabetes to understand if technology is right for them; help them access and learn to use to technology to better manage their diabetes.
Continuous glucose monitoring (CGM)
CGM gives people living with diabetes the opportunity to review their blood glucose as a complete picture over time, rather than at one point in time. It also allows for better shared decision-making with healthcare professionals.
Handy links:
West Yorkshire Integrated Care Board Commissioning Policy
West Yorkshire Integrated Care Board formulary for CGM
West Yorkshire Integrated Care Board supporting guidance and evidence base for CGM position
Hybrid closed loop (HCL) systems
Hybrid closed loop systems, sometimes called an ‘artificial pancreas’, enable an insulin pump and a continuous glucose monitor to work together to help manage blood sugar levels.
A continuous glucose monitor automatically senses sugar levels in the fluid between the blood vessels and cells, without the need for finger-prick testing. A computer programme on a phone or inside an insulin pump uses this data to work out how much insulin the body needs to help keep blood sugar levels stable. The pump then automatically gives the right amount of insulin.
Following the publication of the NICE Technology Appraisal for hybrid closed loop, NHS England published a national HCL five year implementation strategy. In response, West Yorkshire has developed a local delivery plan for HCL which describes who is eligible for HCL and when they can expect to access HCL over the five-year implementation period.
In line with national guidance and available funding from NHS England, we will prioritise children and young people (those aged 18 and under) and people who are receiving maternity diabetes services. The West Yorkshire HCL delivery plan began on 1 April 2024. From 1 April 2025 to 31 March 2026, we are prioritising the following groups of people living with type 1 diabetes:
- children and young people (aged 18 and under)
- people who are receiving maternity diabetes services
- all adults (aged 19 and over) with debilitating recurrent hypoglycaemia who meet pre-defined criteria
In years three to five, there will be a further phased introduction of HCL systems for the adult population living with type 1 diabetes in West Yorkshire. We will review the delivery plan annually, for each year of the five-year implementation period. This will ensure access to HCL for those eligible aligns with the funding available and the ability of the diabetes workforce to support people to use the technology.
The West Yorkshire HCL Delivery Plan is not yet available to share on this webpage. This is because we are developing one West Yorkshire diabetes med-technology commissioning policy and implementation plans (plans for both CGM and HCL). The existing West Yorkshire Commissioning Policy for CGM will be incorporated into this new policy. We will also produce a plain English and easy read version of the new combined policy. It is hoped these documents will be available on this website page by the end of June 2025.
Questions and answers on HCL access in West Yorkshire
Where can I get more information?
- Diabetes UK new continuous glucose monitor available
- Quality statement 4: continuous glucose monitoring for adults who use insulin and need help monitoring their blood glucose | Type 2 diabetes in adults | Quality standards | NICE
- NHS England - glucose monitoring for patients living with diabetes
This NHS decision support tool helps people understand the diabetes technologies available in the NHS and which they are eligible for. It can be used to support discussions between someone living with type 1 diabetes and their healthcare professional.
There is also useful information on the Diabetes UK website about hybrid closed loop systems and a helpful video on the Breakthrough T1D UK website.
The NHS England HCL webpage includes information about the benefits of HCL, who is eligible and how it will be made available across the NHS in England.
The NHS Health A-Z provides information about the treatment for type 1 diabetes which also has information about HCL, who it is suitable for and the phased rollout.
Further information on managing type 1 diabetes is also available on the nhs.uk website.
The Juvenile Diabetes Research Foundation (JDRF) has put together frequently asked questions about eligibility of HCL to help people understand what this may mean for them.
People living with diabetes can talk to their diabetes care team if they have clinical questions.
Other medicines and monitoring information
Anticholinergic medicines include:
- Bladder control medicines such as oxybutynin, tolterodine, solifenacin and trospium
- Antidepressants such as paroxetine and amitriptyline
- Allergy medicines such as chlorphenamine (Piriton for example) and hydroxyzine
- Medicines for nerve pain such as amitriptyline and nortriptyline
- Non-prescription sleeping tablets such as diphenhydramine (Nytol for example) and promethazine (Night Nurse for example).
There are possible side effects of taking these medicines. If you are already taking an anticholinergic medicine to help your symptoms or your doctor, nurse or pharmacist has suggested that you start taking one, the anticholinergic medicines information on this page will help you decide if this is the best option for you.
Update 31 January 2024 - Changes to the commissioning policy for gluten-free prescribing
The ICB Transformation Committee will meet in February 2024 to review new information and decide whether to continue providing gluten-free products on prescription. Please see the full update on this page Treatments paid for by the NHS.
The NHS began funding gluten-free products for people with coeliac disease and people with other gluten-sensitive conditions in the late 1960s when availability of gluten-free products was very limited. Once a wide variety of gluten-free products became available in supermarkets, many areas in England stopped providing them on prescription.
Gluten-free prescribing was stopped in Bradford District and Craven in 2016, and in Kirklees and Wakefield District in 2017. However, in Calderdale and Leeds limited gluten-free products were still prescribed.
At its meeting on 31 October 2023, the NHS West Yorkshire Integrated Care Board (ICB) Transformation Committee agreed that gluten-free prescribing would be stopped in Calderdale and Leeds to bring them in line with the other West Yorkshire places (Bradford District and Craven, Kirklees and Wakefield District). This does not apply to patients who require low protein gluten-free foods.
It may be helpful to note please that we work alongside our colleagues as part of the clinical and care professional forum, which includes doctors, and that no decision is taken lightly.
All gluten-free prescriptions will be stopped from 1 April 2024 so patients will have an adjustment period of around five months to find ways to adapt their diets. Gluten-free prescriptions are not available for those newly diagnosed with coeliac disease from 1 November 2023.
- Hydroxychloroquine and chloroquine retinopathy monitoring - clinical pathway and commissioning policy for adults and children (06.23)
- Patient information leaflet - Eye monitoring for patients taking hydroxychloroquine or chloroquine (06.23)
- Referral form for hydroxychloroquine and chloroquine retinopathy monitoring
- Hydroxychloroquine and chloroquine amber guidance (03.24)
Guidance: Prescribing Specialist Infant Formula in Primary Care - January 2024
Guidance for use in: Bradford District and Craven Health and Care Partnership, Calderdale Cares Partnership, Kirklees Health and Care Partnership, Leeds Health and Care Partnership, Wakefield District Health and Care Partnership.
Breast milk is the optimal milk for infants. Breastfeeding should be promoted and encouraged where possible. This guidance aims to assist GPs and Health Care Professionals with information on the indications and appropriate prescribing of infant formula.
Prescription infant formula is recommended only when there is a medical need and the formula required is not widely available from retailers.
This document is for use within the NHS and is not for commercial or marketing purposes.
6 November 2024
Acute management of potential adverse treatment effects of Lecanemab
Alzheimer’s Disease, the most common cause of dementia, is in part caused by an abnormal build-up of proteins within the brain.
Lecanemab is a medication that targets these abnormal proteins and is now licensed for use in Great Britain. However, in line with the current draft NICE recommendation, Lecanemab will not be available in the NHS in England, but may be available through independent sector providers.
This information note on the Acute Management of Potential Adverse Treatment Effects of Lecanemab provides a short briefing for clinical teams who may be asked to support referrals for private treatment or otherwise assess, advise and possibly treat a small number of patients who could present with potential adverse treatment effects, including symptomatic Amyloid-Related Imaging Abnormalities (ARIA).
- WY Commissioning Policy for Lidocaine Patches - Paediatrics (December 2021)
- Lidocaine Plasters/Patches in Paediatrics - specialist initiation additional guidance
Lipids are types of fat that are transported in the bloodstream. They have several functions, including energy storage. Examples of lipids include cholesterol and triglycerides.
Having high levels of ‘bad cholesterol’ (LDL-cholesterol) and triglycerides can increase the risk of developing cardiovascular disease, as can having low levels of ‘good cholesterol’ (HDL-cholesterol).
Lipid management for patients who already have cardiovascular disease, and for those who are at risk of developing cardiovascular disease, is very important. Your GP or other health professional may treat your high cholesterol or high blood pressure in line with treatment guidance, depending on what’s right for you.
This summary of national guidance for lipid management for primary and secondary prevention of CVD has been developed to support clinicians, along with this treatment guidance for uncomplicated hypertension (high blood pressure) which has been developed following extensive consultation with clinicians and other stakeholders including Public Health England, British Heart Foundation and our local pharmacy committees.
The West Yorkshire and Harrogate Healthy Hearts website also holds a number of other clinical resources developed to support clinicians in preventing cardiovascular disease.
27 January 2023
Work is ongoing on classification and transfer of care document.
24 December 2024
Patient information about tirzepatide (Mounjaro) for weight loss
Mounjaro is the brand name for tirzepatide. It is a medication used with diet, exercise, and support to help with weight loss for people living with overweight or obesity.
Mounjaro is being approved for NHS prescribing. However, initially it will only be available through specialist pathways, not directly from your GP. These pathways are being finalised and will follow national guidelines.
Due to the high cost of the medication and phased NHS rollout, not everyone will qualify for treatment immediately.
We will share updates about availability and care pathways on the medicines section of our website.
For more support with healthy eating and weight loss see:
We appreciate your patience as we work to introduce this new medication responsibly.
Please see these questions and answers for more information. Also see the National Institute for Health and Care Excellence (NICE) Tirzepatide for managing overweight and obesity pages.
18th March 2025
National patient safety alert
The Department of Health and Social Care (DHSC) and NHS England have issued an updated national patient safety alert covering the shortage of Pancreatic Enzyme Replacement Therapy (PERT) . NatPSA/2024/013/DHSC.
Information for Healthcare Practitioners - PERT Healthcare Practitioners Information
20 December 2024
National patient safety alert
The Department of Health and Social Care (DHSC) and NHS England have issued an updated national patient safety alert covering the shortage of Pancreatic Enzyme Replacement Therapy (PERT). NatPSA/2024/013/DHSC.
Further information for healthcare professionals: PERT Information Healthcare
The Government introduced emergency restrictions on 29 May 2024 on the use of a group of medicines called GnRH analogues where they are used to suppress puberty as part of treating gender incongruence or gender dysphoria in children and young people under 18 years of age. Some of these restrictions took effect from 3 June 2024. The Government’s announcement is published here: https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers.
The new arrangements apply to medicines that consist of or contain:
- buserelin
- gonadorelin
- goserelin
- leuprorelin acetate
- nafarelin
- triptorelin
This includes, but is not limited to, medicines sold under these brand names:
- Decapeptyl®
- Gonapeptyl Depot®
- Salvacyl®
- Prostap®
- Staladex®
- Zoladex®
- Synarel.
As a result of the new Government policy, from 3 June 2024 it became a criminal offence for a pharmacist, doctor or any other individual in Great Britain to sell or supply these drugs to patients under the age of 18 except in the following circumstances:
- The child or young person is using an NHS prescription (for example, from the NHS Children and Young People’s Gender Service or from an NHS GP).
- The child or young person is using a private prescription from a clinician registered in the United Kingdom that fulfils the following criteria:
- If the prescription was dated prior to 3 June 2024, whether as a one off prescription or a repeat prescription, it can still be dispensed, whether the treatment is for gender incongruence/dysphoria or some other purpose. In practice, unless it is a repeat prescription, it will need to have been issued within the previous six months to still be valid.
- If the prescription is written on or after 3 June 2024, it can only be dispensed if it is written by a UK-registered doctor, nurse or pharmacist, whatever its purpose. It must be either for a purpose other than treatment for gender incongruence or, if it is for gender dysphoria/incongruence, the patient must have started treatment before 3 June 2024. In addition to those patients who have actually started treatment, patients are treated as having started treatment, whether or not they have actually taken a GnRH analogue, if they were prescribed with a GnRH analogue on or after 3 December 2023.
It will also be a criminal offence to possess these medicines, where the individual had reasonable cause to know that the medicine had been sold or supplied in breach of the ban.
Additionally, from 26 June 2024 NHS prescribers in GP practices in primary care will only be able to supply – or continue to supply - prescriptions for GnRH analogues in the following circumstances:
- the patient is aged 18 years or over or
- the patient is 17 years or under and has started treatment with these medicines (they will be treated as having started treatment if they have been issued with a Copyright © NHS England 2024 3 prescription for these medicines since 3 December 2023, even if they have not yet started to take the medicine) or
- the patient is 17 years or under and is being treated with GnRH analogues for gender incongruence or gender dysphoria by the NHS as part of a future clinical trial overseen by the National Institute for Health and Care Research or
- the patient is 17 years or under and the purpose of the prescription is for a medical condition other than gender incongruence or gender dysphoria.
From 3rd June, private prescriptions of GnRH analogues from a prescriber registered in the European Economic Area (EEA) or Switzerland are banned from being supplied in Great Britain in all circumstances for patients aged under 18.
NHS England sent this letter to everyone who is on the waiting list for the NHS Children and Young People’s Gender Service in May 2024.
Sativex® is a medicine that can be used to treat symptoms of moderate to severe spasticity (muscles feeling stiff, heavy and difficult to move) in patients with MS. The ICB is having discussions with local clinical specialists on how we can use Sativex® alongside existing treatment options for MS as per NICE guidance (NG144). Until these discussions have taken place, Sativex® is still classified as ‘do not prescribe’ which means it cannot be prescribed by healthcare professionals working across West Yorkshire.
Fertility, contraception and pregnancy
Sodium valproate, usually referred to as just ‘valproate’, is used to treat epilepsy and bipolar disorder. It can also prevent migraine. You may be more familiar with the brand names of medicines containing valproate which include Epilim® and Depakote®.
Research shows that valproate can seriously harm an unborn baby when taken during pregnancy. Birth defects include spina bifida (where the bones of the spine do not develop properly), malformations of the face, eyes or certain organs, and hearing problems. Where valproate is used during pregnancy, around 10 babies in every 100 will have a birth defect. In comparison, for pregnancies in which valproate is not used, around 2 to 3 babies in every 100 will have a birth defect.
In January 2024, strict guidelines were released:
- All new patients prescribed valproate aged under 55 years, two specialists must agree that your condition does not respond to other treatments or other treatments are not tolerated.
- For people with female reproductive organs, aged under 55 years taking valproate, two independent specialists must agree that your condition does not respond to other treatments or other treatments are not tolerated and document this at your next annual review.
- For people with male reproductive organs new information about the risks associated with use of valproate in male patients should be shared.
In addition, if you are under 55 and are able to get pregnant, your specialist will put you on the UK Valproate Pregnancy Prevention Programme. This is to reduce the risk of you getting pregnant whilst using valproate. On this programme, you must:
- use highly effective birth control such as an intrauterine device (coil) or implant the whole time you are taking valproate
- complete an ‘annual risk acknowledgement form’ to confirm that you understand and agree to follow the rules of the pregnancy prevention programme
You may find this information worrying but it’s important that you do not stop taking valproate without checking with your specialist or GP first.
If you find out that you are pregnant, you must seek expert medical help within the next 24 hours. Healthcare professionals will help you stop using valproate as quickly and as safely as possible.
If you are not pregnant but want to try for a baby, make an urgent appointment with your GP. They will refer you to a specialist who will be able to give you the best advice. Do not stop using birth control until you and your specialist have agreed on the best treatment option for you.
If you would like to know more, the NHS website has more information on valproate.
You can report any side effects whilst taking valproate to www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
NHS West Yorkshire Integrated Care Board (ICB) commissions the following use of VEGF inhibitors
- All patients stabilised on Ranibizumab (Lucentis®) should be transferred to biosimilar ranibizumab (Ongavia®). Patient consent and consultation should be undertaken as per local trust policies.
- Treatment naïve patients can be started on faricimab (Vabysmo®)
- Patients already on facricimab (Vabysmo®), including those exiting a trial. should continue to receive faricimab (Vabysmo®).
- Patients where it has not been possible to stabilise on injections of ranibizumab every eight weeks can be considered for treatment with faricimab (Vabysmo®).
- Patients where it has not been possible to stabilise on injections of aflibercept (Eylea®) every eight weeks can be considered for treatment with faricimab (Vabysmo®).
- Patients not stable on brolucizumab (Beovu®) can be considered for a switch to treatment with faricimab (Vabysmo®)
- Patients currently using bevacizumab (Avastin®) may continue treatment if stable.
Wednesday 6 November 2024
Please see this information Access to weight loss drugs in West Yorkshire for the latest information about semaglutide (Wegovy),
Thursday 7 September 2023
On 4 September, the news reported that some NHS patients could be prescribed the Wegovy weight-loss drug after limited stock arrived in the UK. We are awaiting national guidance for when Wegovy will be available and for which patients, though it is anticipated that this will only be available to patients who are already under a Tier 3 weight management service and as part of a national pilot. Tier 3 weight management services provide non-surgical intensive treatment and support for the management of obesity.
Over the coming weeks we hope to receive clarity from NHS England on which West Yorkshire weight management services may have access to appropriate supplies to commence mobilisation and delivery as part of this national pilot safely.
At this time Wegovy is not available through your GP or any West Yorkshire weight management services.
We will update as we know more.
Wednesday 7 June 2023
NHS West Yorkshire Integrated Care Board (ICB) welcomes the news that considerations are being given on how to expand weight management offers to people in England. Wegovy is not currently available for prescribing. This is likely to be rolled out as an initial pilot project and at this time we do not know which areas will be pilot sites. We greatly appreciate that demand for these medications is likely to be high and will work in the coming weeks to gain clarity of what is likely to be the offer.
As supplies of Wegovy have not yet been made available in the UK by the manufacturer, there has been an increase in demand for off label use of Ozempic and Rybelsus, which has led to shortages of these drugs to treat people with type 2 diabetes. Ozempic and Rybelsus are only licensed for type 2 diabetes and as such must only be used for patients with type 2 diabetes.
West Yorkshire ICB does not support the off-label use of Ozempic or Rybelsus for weight loss treatment.
We know that obesity is particularly prevalent in low Index of Multiple Deprivation (IMD) areas and those most in need may not be able to afford to self-fund such a medication, so we want to ensure our commissioning policy reflects this. We will work to keep you updated on timescales and more detailed plans as they develop.
Please see the contact details below for any enquiries:
Email: Westyorkshire.
Telephone: 01924 317659