The cautions for use in liver impairment have also been updated. The manufacturers now detail that no dose adjustment is recommended for patients with mild or moderate hepatic impairment. Liraglutide is not recommended for use in patients with severe hepatic impairment.
NICE NG28: Diabetes in adults: management, recommends that where metformin is not tolerated or contra-indicated a dipeptidyl peptidase 4 (DPP-4) inhibitor, pioglitazone or a sulfonylurea are options for monotherapy for glycaemic control in type 2 diabetes.
NICE TA390 recommends canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes in adults for whom metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control, only if a DPP 4 inhibitor would otherwise be prescribed and a sulfonylurea or pioglitazone are not appropriate.