GPAtlas🧭 When to consider (indications)
Glucagon-like peptide-1 (GLP-1) receptor agonists, and the newer dual GIP/GLP-1 receptor agonist tirzepatide (GIP = glucose-dependent insulinotropic polypeptide), are injectable incretin mimetics: they copy gut hormones released after eating to lower blood glucose, curb appetite and slow gastric emptying.
Most are given once weekly; liraglutide is once daily. They are an adjunct to diet and exercise.
Since the February 2026 NICE NG28 update they enter treatment early rather than only after oral therapy fails: in atherosclerotic cardiovascular disease, subcutaneous semaglutide is part of first-line treatment from the start.
In UK primary care they have two main licensed roles – glycaemic control in type 2 diabetes (T2DM) and weight management.
Each is governed by a specific National Institute for Health and Care Excellence (NICE) appraisal with its own body mass index (BMI) threshold, prescribing setting and stopping rule.
The central primary-care skills are to:
• Confirm the patient meets the right criteria
• Prescribe and titrate safely
• Apply the continuation rule
• Counsel on the key risks – above all pancreatitis and pregnancy
| Indication | Who qualifies (in brief) | Where prescribed |
|---|---|---|
| T2DM – glucose control (NG28/TA924) |
NICE NG28 (February 2026): considered alongside modified-release metformin and an SGLT-2 inhibitor in: • Early onset type 2 diabetes (diagnosed before 40) • Obesity, added after at least 3 months if glycaemic targets are not met • In atherosclerotic cardiovascular disease, semaglutide up to 1 mg weekly is offered instead. |
Primary care (initiation or shared care) |
| Weight – tirzepatide (Mounjaro, TA1026) | • BMI ≥ 35 + at least 1 weight-related comorbidity • Phased NHS rollout, highest-risk first |
Primary care and specialist services |
| Weight – semaglutide/liraglutide (TA875) | • BMI ≥ 35 (or 30–34.9 meeting referral criteria) + 1 comorbidity • Semaglutide capped at 2 years |
Specialist weight management service only |
| Cardiovascular risk: semaglutide (Wegovy, TA1152) | • Established CVD (previous myocardial infarction, previous ischaemic or haemorrhagic stroke, or symptomatic peripheral arterial disease) and BMI ≥ 27 kg/m² • Up to 2.4 mg once weekly |
Setting not specified by NICE, so primary care or specialist |
A major recent change: tirzepatide (Mounjaro) is now prescribable in primary care for weight management under NICE technology appraisal TA1026, through a phased NHS rollout.
• For weight loss, semaglutide (Wegovy) and liraglutide (Saxenda) remain specialist-service only.
• Whichever the indication, the medicine is always given alongside a reduced-calorie diet and increased physical activity.
Source: NICE NG28 · NICE TA924 · NICE TA1026 · NICE TA875
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.