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Type 2 diabetes in line with NICE TA336. CKD treatment in line with NICE TA942. See local CKD pathway.

Guidance on Generic SGLT2i Prescribing in LLR

Dapagliflozin is First Line in LLR

Conditional on prescriber being competent to select appropriate patients.

Fiasp (insulin aspart) FlexTouch 100units/ml solution for injection 3ml pre-filled pens have been out of stock since 31^st March 2024 and have subsequently been discontinued. Prescribers should not initiate patients on Fiasp FlexTouch 100units/ml pre-filled pens and should instead consider Fiasp Penfill cartridges where reusable pens are available as sufficient cartridges to support increased demand.

In UHL where access to reusuable pens is limited following SBAR should be followed: SBAR Fiasp®

Conditional on prescriber being trained to select appropriate patients
MUST BE PRESCRIBED BY BRAND NAME

Tresiba (insulin degludec) FlexTouch 100units/ml solution for injection 3ml pre-filled pens have been out of stock since 31^st July 2023 and have subsequently been discontinued. Prescribers should not initiate patients on Tresiba FlexTouch 100units/ml pre-filled pens and should instead consider Tresiba Penfill cartridges where reusable pens are available as sufficient cartridges to support increased demand. In the community, reusable pens are normally issued at same time as initial cartridge prescription.  UHL continue to have no supplies of the reusable pens so will need to follow the SBAR with respect to changing to higher strength flextouch for Tresiba.

In UHL where access to reusable pens is limited following SBAR should be followed Tresiba® Flextouch SBAR

Rectal Use.

Use Cleen Ready-to-Use Enema as the preferred option due to lower cost.

Due to the risk of infection, enemas should not be used in patients on chemotherapy or neutropenic patients.

Conditional on prescriber being competent to select appropriate patients.

First choice GLP-1 RA for T2DM new starts where BMI < 35 in line with NICE NG28

First choice GLP-1 RA for T2DM new starts where BMI > 35 – SC Semaglutide (Ozempic) or SC Tirzepatide (Mounjaro) in line with NICE NG28

Sildenafil generic is first line choice due to lower cost.

For patients who have not responded to sildenafil.

10mg and 20mg for PRN dosing.

Approved for daily administration for individuals requiring more than 4 doses per month.

Do not prescribe 2.5mg OD dosing.

Higher cost than both tadalafil and sildenafil.

Third line choice after sildenafil and tadalafil where these products are appropriate to use.