Tresiba

[drahawkins_1973]

HI all,

I posted a question regarding splitting my levemir dose recently and Robert and Noblehead suggested trying Tresiba instead. I booked an appointment with my GP who really understands diabetes to disucss it with him this morning. When I got there it turns out he no longer works there so had to see another doctor (what a pain had just broken in the old one too )

I know some people have said they have had dffiiculty in getting it due to costs so I was very prepared with my arguments ready. I had worked out all the reason I wanted it, how much more it would cost etc.....anyway it turns out he'd never heard of it!

So he didnt want to prescribe it, but only because he said he didnt know enough about it. He aked me to send him my reasoning why I wanted it and he'd follow up with a diabtetic specialist.

Wasn't an absolute no but not a yes either :-(

Fingers crossed they'll get back to me soon and say yes!
Andrea

 

[smidge]

Hi Andrea. Well, that's a start at least.

I found a paper earlier today from the Nottingham NHS. It was from earlier this year and stated that Tresiba has a amber2 status which means it can't be prescribed initially by a GP, but the GP can take over prescription of it once a specialist has initially prescribed it. It went on to say that it should only be prescribed for existing Lantus users who are experiencing severe hypos, particularly at night. There was another reason it could be prescribed, but I can't remember that - it didn't apply to me. I'm guessing these were local guidelines in the Nottingham area and down to cost, but I'm not sure. If I can find it again I'll post the link.

Smidge

 

[noblehead]

Nice one Andrea, I'm sure Rob will help you out here, but that's good thaat the Dr didn't just refuse it on the bases of cost

 

[drahawkins_1973]

Hi Andrea. Well, that's a start at least.

I found a paper earlier today from the Nottingham NHS. It was from earlier this year and stated that Tresiba has a amber2 status which means it can't be prescribed initially by a GP, but the GP can take over prescription of it once a specialist has initially prescribed it. It went on to say that it should only be prescribed for existing Lantus users who are experiencing severe hypos, particularly at night. There was another reason it could be prescribed, but I can't remember that - it didn't apply to me. I'm guessing these were local guidelines in the Nottingham area and down to cost, but I'm not sure. If I can find it again I'll post the link.

Smidge

Thanks Smidge

 

[smidge]

Well, couldn't work out how to post the link, but here's what it says from 17 July this year:

Insulin Degludec (Tresiba®, NovoNordisk) resubmission

A joint submission for insulin degludec had been received from NUH and SFH diabetologists in October 2013 and there had been ongoing discussions regarding place in therapy prior to bringing the submission to APC. Concerns had been raised regarding the prescribing criteria not correlating with expected patient numbers, cost-effectiveness, affordability and safety concerns regarding two strengths being available. Dr Mansell, Diabetologist, NUH, had attended JFG to discuss the item at the June meeting. Based on discussions at that meeting and subsequent further review of the evidence during this meeting the requested criteria has been revised to be only for:
6
Patients with type 1 diabetes currently treated with insulin glargine with recurrent admissions for ketoacidosis treatment due to insulin omission.

Patients with type 1 diabetes currently treated with insulin glargine with recurrent, particularly nocturnal, severe hypoglycaemia.

Based on the JFG assessment, the APC indicated an AMBER 2, consultant only initiation classification for the revised criteria might be supported with the assumption that the change to insulin degludec would reduce admissions in this niche group of patients. The committee noted that there was no evidence to support the reduction in hospital admissions for DKA and that the evidence for reducing severe nocturnal hypoglycaemia was weak. However, the patient groups that were likely to benefit from an ultra-long acting insulin were excluded from trials and it would seem logical to assume that there would be benefit in these patient groups.

Patient numbers need to be agreed and place in therapy clarified with both trusts, perhaps with the aid of a flowchart. It was noted that Leicestershire have developed a flowchart that could be shown to clinicians as an example. Individual patient benefit would need to be assessed after an agreed period (e.g. 6-12 months), with the view to changing back to a standard long acting insulin if insufficient improvement demonstrated.

Action: JS/JT to feedback to clinicians and request clarity on place in therapy and patient numbers for revised criteria. NB/AR to contact PH for info on likely patient numbers JS/JT to send place in therapy to members for ratification via email

Post meeting note: Insulin degludec is available as a lower strength of U100 in addition to the U200. The need for the higher strength U200 insulin degludec for these patients is considered unlikely based on the above criteria and this preparation will not be approved for formulary use (GREY – non-formulary) due to safety concerns over having a higher strength insulin available.

Smidge

Edited to make formatting easier to read.

 

[drahawkins_1973]

Cheers Smidge.
I dont really fall into any of those categories One of my reasonings to my GP was that as I'm only on such small basal doses it wont really cost them much more (about £70 a year!)....not sure how well balanced that argument is but worth a try

 

[robert72]

Hi Andrea

I initially asked my GP about trying Tresiba but, like yours, he said he didn't feel comfortable about prescribing it as he'd had no experience of it. I had not been under a consultant for some time so asked if he would refer me, which he was happy to do.

The consultant said that I should try splitting my Lantus to see if that worked and that he was happy for my GP to prescribe Tresiba if it didn't.

Splitting the Lantus didn't help me, so I asked my GP for Tresiba to which he agreed... whilst muttering about his prescribing budget

 

[ManUtdGal!]

I was on Levemir and had to split it in 2 as it wasn't working well for me and my Diabetes nurse at my GP surgery changed me to Tresiba. Much better. Only in disposable pens at the moment but is working much better for me. It depends on the area you are in for who prescribes it but I have only had it from my GP. I don't go to a hospital clinic as my GP does a Diabetic clinic. Everyone has the right to be on the insulin they need and don't take no for an answer. It is you who has to live with it not the Drs.

 

[robert72]

I was on Levemir and had to split it in 2 as it wasn't working well for me and my Diabetes nurse at my GP surgery changed me to Tresiba. Much better. Only in disposable pens at the moment but is working much better for me. It depends on the area you are in for who prescribes it but I have only had it from my GP. I don't go to a hospital clinic as my GP does a Diabetic clinic. Everyone has the right to be on the insulin they need and don't take no for an answer. It is you who has to live with it not the Drs.

The U200 strength is only available in disposable pens, the U100 strength also come in cartridges - I use them in my NovoPen Echo

 

[ManUtdGal!]

Oh didn't know that. I prefer the cartridges as seems such a waste to throw a whole pen away. I'll ask my GP about it. Thanks

 

[searley]

I'm t2 on degludec/tresiba was prescribed by my consultant initially works well for me

 

[smidge]

I'm in Leicestershire, so according to the blurb from Nottinghamshire, I'm going to have to convince a flowchart that I should have Tresiba LOL.

Smidge

 

[drahawkins_1973]

I'm in Leicestershire, so according to the blurb from Nottinghamshire, I'm going to have to convince a flowchart that I should have Tresiba LOL.

Smidge

Bonkers isnt it.


I'm Reading , Berkshire.....so dont know what their policy is. Probably just as made up.

 

[smidge]

Ok, so I found the Leicestershire flowchart. This is what I'm up against - and I fall at the first hurdle as I'm not on Lantos:

http://www.google.co.uk/url?sa=t&rc...nygZgB&usg=AFQjCNHCqRp7NOxUtZm7JEpelbbQ6rA0PQ

Smidge

 

[robert72]

Ok, so I found the Leicestershire flowchart. This is what I'm up against - and I fall at the first hurdle as I'm not on Lantos:

http://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCcQFjAB&url=http://www.lmsg.nhs.uk/LMSGDocs%5CGuidelines%5CAlgorithmDegludec100Reformat.pdf&ei=zWJvVJ6JCca_PMnygZgB&usg=AFQjCNHCqRp7NOxUtZm7JEpelbbQ6rA0PQ

Smidge

Even then, it seems they are prepared to fund a pump before letting you loose with Tresiba on cost grounds

 

[tim2000s]

Even then, it seems they are prepared to fund a pump before letting you loose with Tresiba on cost grounds

That's what I thought too! Nice to be in Leics!

 

[drahawkins_1973]

http://www.google.co.uk/url?url=htt...oQFjAB&usg=AFQjCNHH-vc81mbVJ1sf-nCDe_JaBdfnzQ

Apparently not recommended in Berks either but it does say that an indiviual GP can overule if they feel necessary.

 

[smidge]

That's what I thought too! Nice to be in Leics!

Actually, the consultant who is trialling Tresiba on some of his patients is actually a big supporter of the pump. I met him a while back and tried to convince him CGM would be a better investment of NHS funding than the pump, but he wasn't convinced. My consultant could be easily persuaded to recommend me for a pump, but I really don't want to hand control over to a device like that - I know I must be the only diabetic in the country who doesn't want one. I think I have an impossible task getting either of them to prescribe Tresiba though.

I'm thinking along the lines - Levemir isn't working for me - my SDfrom Mean has more than doubled since using it - Insuman Basal was giving me mid-morning hypos, so would rather not go back to that - I think it's unreasonable to expect me to add a third basal injection to get Levemir to last the day - don't want Lantus because it is known to cause nasty, unpredictable hypos (especially at night in some people) and I don't feel it's worth the risk - we need to get a good steady base line before we can sort out the after food spikes - why not try Tresiba for 6 months to see how I get on and review at the end of that?

Do you think that will convince the flowchart?

Smidge

 

[robert72]

Actually, the consultant who is trialling Tresiba on some of his patients is actually a big supporter of the pump. I met him a while back and tried to convince him CGM would be a better investment of NHS funding than the pump, but he wasn't convinced. My consultant could be easily persuaded to recommend me for a pump, but I really don't want to hand control over to a device like that - I know I must be the only diabetic in the country who doesn't want one. I think I have an impossible task getting either of them to prescribe Tresiba though.

I'm thinking along the lines - Levemir isn't working for me - my SDfrom Mean has more than doubled since using it - Insuman Basal was giving me mid-morning hypos, so would rather not go back to that - I think it's unreasonable to expect me to add a third basal injection to get Levemir to last the day - don't want Lantus because it is known to cause nasty, unpredictable hypos (especially at night in some people) and I don't feel it's worth the risk - we need to get a good steady base line before we can sort out the after food spikes - why not try Tresiba for 6 months to see how I get on and review at the end of that?

Do you think that will convince the flowchart?

Smidge

I agree - ask for a trial of Tresiba for even 3 months

 

[smidge]

I agree - ask for a trial of Tresiba for even 3 months

Yeh, I was thinking of not fessing up to having found the flowchart, but suggesting a 6 month trial and letting him bargain me down to 3 LOL.

Smidge