1. MEDICINES OPTIMISATION IN DIABETES Yvonne Parker Medicines Optimisation Pharmacist Stoke-on-Trent CCG

2. Current Prescribing Trends CCG Total Cost 2013/14 Total Items 2013/14 Total Cost 2014/15 Total Items 2014/15 % Growth in Cost Stoke-on-Trent £3,501,381261,712£3,791,344273,258 8% North Staffs £2,496,073172,374£2,699,642177,478 8% England Total £622,417,67337,792,688£669,032,45139,415,271 7% Figures taken from PrescQIPP Drugs used for diabetes snapshot 2014/15 – April to January

3. Growth by BNF chapter – Actual Growth Cost Top 6 BNF chapters (highest to lowest growth cost): Stoke-on-TrentNorth Staffs Endocrine System Nutrition and Blood Respiratory SystemStoma Appliances Gastro-Intestinal System Appliances Stoma AppliancesImmunological Products & Vaccines

4. Endocrine System Growth CCGActual Growth Items Actual Growth Cost % Growth Items % Growth Cost Difference in cost per item Stoke-on- Trent 18,568£491,3563.61%9.38%£0.57 - Endocrine £0.55 - Diabetes North Staffs 8,605£367,1652.29%9.48%£0.72 - Endocrine £0.77 - Diabetes Actual growth April to February 13/14 vs 14/15

5. Top 10 Diabetes Drugs/Reagents by Cost Stoke-on-Trent (2014/15)North Staffs (2014/15) Drug/ReagentCostNo. of ItemsDrug/ReagentCostNo. of Items BGTS£646K37,247BGTS£497K26,075 Metformin HCl£614K128,930Metformin HCl£436K81,543 Insulin glargine£404K8,178Insulin glargine£377K7,400 Sitagliptin£365K11,621Sitagliptin£274K7,769 Biphasic insulin aspart£312K7,324Biphasic insulin aspart£195K4,410 Exenatide£266K3,401Insulin aspart£191K4,996 Insulin aspart£255K6,420Gliclazide£132K35,946 Liraglutide£233K2,011Exenatide£125K1,578 Gliclazide£215K60,236Liraglutide£106K982 Linagliptin£132K4,276Insulin detemir£100K1,801

6. Main areas of concern Stoke-on-Trent 2,000% (£18,500) increase in insulin degludec 250% (£5,600) increase in combination product sitagliptin/metformin (Janumet) North Staffs 365% (£10,000) increase in insulin degludec 11% (£10,000) increase in liraglutide

7. Main areas of improvement Stoke-on-Trent Decreased spend on non-formulary drugs Decreased spend on BGTS Decreased spend for 3 combination products North Staffs Decreased spend on non-formulary drugs Decreased spend for 3 combination products

8. North Staffordshire Joint Formulary AIMS: To promote safe, effective and economic prescribing in both primary and secondary care Help to ensure seamless prescribing, thereby reducing possible errors and confusion Each section approved by the North Staffordshire and Stoke-on-Trent Area Prescribing Committee

9. Medicines are categorised according to a traffic light system The formulary can be found at: http://www.stokeccg.nhs.uk/joint-formularyhttp://www.stokeccg.nhs.uk/joint-formulary

10. 1 st line – Byetta (exenatide twice daily) 2 nd line – Bydureon (exenatide once weekly) 3 rd line – Victoza (liraglutide once daily) Essential Shared Care Agreements (ESCAs) set out specialist, GP and patient responsibilities and are required due to the amber 1 classification of GLP1s on the formulary GLP-1 mimetic prescribing and ESCAs

11. 7 GP practices in Stoke are taking part in the GLP1 LIS service Prescribing needs to be in line with NICE guidance Triple therapy – 1.0% reduction in HbA1c and 3% reduction in weight 6 months after initiation Dual therapy – 1.0% reduction in HbA1c 6 months after initiation GLP-1 mimetic prescribing and ESCAs

12. Guidelines for diabetes Management of adults with diabetes mellitus – Guidelines for clinical care At-a-glance guide for self monitoring blood glucose (SMBG) in diabetes Patient guide for self monitoring of blood glucose (SMBG) in diabetes At-a-glance guide for treatment with a 3 rd line oral agent for patients with type 2 diabetes

13. Medicines Optimisation Projects Prescribing of WaveSense JAZZ BGTS and supplying the meter to all suitable patients Prescribing of Omnican Fine or GlucoRx FinePoint pen needles to all suitable patients A review of the prescribing of 3 rd line oral antidiabetic agents in the management of type 2 diabetes

14. Any questions?