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, never a first-line therapy.
In UK primary care they have two main licensed roles – glycaemic control in type 2 diabetes (T2DM) and weight management – each 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, and counsel on the key risks – above all pancreatitis and pregnancy.
| Indication | Who qualifies (in brief) | Where prescribed |
|---|---|---|
| T2DM – glucose control (NG28 / TA924) | After metformin + 2 oral agents fail; BMI ≥ 35 with obesity-related problems (lower threshold for some ethnic groups) | 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 |
A pivotal recent change: tirzepatide (Mounjaro) is now prescribable in primary care for weight management under NICE technology appraisal TA1026, through a phased NHS rollout – whereas semaglutide (Wegovy) and liraglutide (Saxenda) for weight loss 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
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