Presentation (CTI)

OBJECTIVES: Obesity and diabetes impose a substantial clinical and economic burden in the UK. Despite a range of available interventions, including lifestyle adjustments, insulin, and metformin, many patients fail to achieve or maintain adequate glycemic control and weight loss, indicating persistent unmet need. This review investigates how unmet needs are described and applied in NICE health technology assessment (HTA) submissions for obesity and diabetes.
METHODS: HTA submissions to NICE addressing obesity, type 1 diabetes (T1D), and type 2 diabetes (T2D) between 1^st January 2020 and 1^st April 2025 were reviewed, excluding terminated appraisals. Unmet needs raised by the sponsor, clinical experts, and patient/professional organizations were extracted by one researcher and independently validated by another.
RESULTS: Six HTA submissions were identified: three addressed obesity, two addressed T1D, and one addressed T2D. There were five single technology appraisals and one multiple technology appraisal. For diabetes, clinical experts and professional organizations described the need for more effective treatments because large proportions of patients fail to meet glycemic, weight, blood pressure, and lipid targets. Sponsors and clinical experts flagged comorbid obesity as a concern, noting its link to poor glycemic control and highlighting the need for treatment options supporting weight loss. For obesity, clinical experts, patient organizations, and professional organizations agreed that NHS tier 3-4 treatments (e.g. multidisciplinary weight management and bariatric surgery) are limited and difficult to access. In the past five years, indications for glucagon-like peptide-1 (GLP-1) agonists have broadened to include overweight patients with comorbidities, improving accessibility. However, clinical experts noted the need for long-term options because the 2-year cap on GLP-1 treatment does not address this chronic condition.
CONCLUSIONS: Stakeholders describe unmet needs for accessible, long-term interventions in diabetes and obesity. Demonstrating sustained benefits across broader patient populations may be key for differentiating new therapies in future HTA submissions.