- Messages
- 8,934
- Type of diabetes
- Type 1
- Treatment type
- Other
There is a lot of discussion amongst T1s about a lot of aspects of care, but one of the most interesting for me is the choice between Levemir and Lantus. Having a spare 30 mins< I thought I'd read the NICE guidelines for Diabetic care, and it reveals a great deal with regard to why certain insulins are selected by GPs/Clinics.
The NICE Guidelines name only NPH and Glargine specifically. There is no mention of Detemir (Levemir) anywhere.
The key recommendation for me from the guideline is R50, which states:
R50 Adults with Type 1 diabetes should have access to the types (preparation and species) A of insulin they find allow them optimal well-being.
As far as I am concerned, this is a legitimate argument for being put onto Degludec.
On the topic of Metformin, the basis of the reasoning for very few T1s being put on it is that there is limited evidence of lowered Hba1C when using Metformin. it is therefore not normally prescribed in the UK, wrongly or rightly, due to R65:
Oral glucose-lowering drugs should generally not be used in the management of adults D with Type 1 diabetes.
On the topic of CGMs, the reason for a complete lack of any of the technology in this area being properly identified is that there has not been a study or enough evidence collected that demonstrates that over the long term, CGMs can have a statistically significant effect on long term diabetes management, indeed the statement is:
However, none of these studies address viable outcomes of glycaemic control or long-term use.
It is recognised as having short term benefits, however, I think we as a community now have a way of providing a proper level of research. The current recommendation is:
Continuous glucose monitoring systems have a role in the assessment of glucose B profiles in adults with consistent glucose control problems on insulin therapy, notably:
● repeated hyper- or hypoglycaemia at the same time of day
● hypoglycaemia unawareness, unresponsive to conventional insulin dose adjustment.
There are now avast number of Libre and Dexcom users. If we could pull the data together and show improvements over the course of 12-24 months, it would provide a body of evidence that could be persuasive.
Having read through the guidelines, I can understand the reticence of the healthcare bodies to prescribe anything useful. NICE needs evidence. We as a community are uniquely positioned to provide that evidence, and I, for one, am up for trying to provide it. Is anyone else?
The NICE Guidelines name only NPH and Glargine specifically. There is no mention of Detemir (Levemir) anywhere.
The key recommendation for me from the guideline is R50, which states:
R50 Adults with Type 1 diabetes should have access to the types (preparation and species) A of insulin they find allow them optimal well-being.
As far as I am concerned, this is a legitimate argument for being put onto Degludec.
On the topic of Metformin, the basis of the reasoning for very few T1s being put on it is that there is limited evidence of lowered Hba1C when using Metformin. it is therefore not normally prescribed in the UK, wrongly or rightly, due to R65:
Oral glucose-lowering drugs should generally not be used in the management of adults D with Type 1 diabetes.
On the topic of CGMs, the reason for a complete lack of any of the technology in this area being properly identified is that there has not been a study or enough evidence collected that demonstrates that over the long term, CGMs can have a statistically significant effect on long term diabetes management, indeed the statement is:
However, none of these studies address viable outcomes of glycaemic control or long-term use.
It is recognised as having short term benefits, however, I think we as a community now have a way of providing a proper level of research. The current recommendation is:
Continuous glucose monitoring systems have a role in the assessment of glucose B profiles in adults with consistent glucose control problems on insulin therapy, notably:
● repeated hyper- or hypoglycaemia at the same time of day
● hypoglycaemia unawareness, unresponsive to conventional insulin dose adjustment.
There are now avast number of Libre and Dexcom users. If we could pull the data together and show improvements over the course of 12-24 months, it would provide a body of evidence that could be persuasive.
Having read through the guidelines, I can understand the reticence of the healthcare bodies to prescribe anything useful. NICE needs evidence. We as a community are uniquely positioned to provide that evidence, and I, for one, am up for trying to provide it. Is anyone else?