Search
Search titles only
By:
Search titles only
By:
Home
Forums
New posts
Search forums
What's new
New posts
New profile posts
Latest activity
Members
Current visitors
New profile posts
Search profile posts
Log in
Register
Search
Search titles only
By:
Search titles only
By:
New posts
Search forums
Menu
Install the app
Install
Reply to Thread
Guest, we'd love to know what you think about the forum! Take the
Diabetes Forum Survey 2024 »
Home
Forums
Diabetes Discussion
Diabetes Discussions
Thoughts on why doctors often prescribe meds for T2 diabetes
JavaScript is disabled. For a better experience, please enable JavaScript in your browser before proceeding.
You are using an out of date browser. It may not display this or other websites correctly.
You should upgrade or use an
alternative browser
.
Message
<blockquote data-quote="tim2000s" data-source="post: 912946" data-attributes="member: 30007"><p>So... The NICE Guidance for T2 is:</p><p></p><ul> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#patient-education" target="_blank">1.1 Patient education</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#lifestyle-managementnon-pharmacological-management" target="_blank">1.2 Lifestyle management/non-pharmacological management</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#glucose-control-levels" target="_blank">1.3 Glucose control levels</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#self-monitoring-of-plasma-glucose" target="_blank">1.4 Self-monitoring of plasma glucose</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#oral-glucose-control-therapies-1-metformin-insulin-secretagogues-and-acarbose" target="_blank">1.5 Oral glucose control therapies (1): metformin, insulin secretagogues and acarbose</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#oral-glucose-control-therapies-2-other-oral-agents-and-exenatide" target="_blank">1.6 Oral glucose control therapies (2): other oral agents and exenatide</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#glucose-control-insulin-therapy" target="_blank">1.7 Glucose control: insulin therapy</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#blood-pressure-therapy" target="_blank">1.8 Blood pressure therapy</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#cardiovascular-risk-estimation" target="_blank">1.9 Cardiovascular risk estimation</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#management-of-blood-lipid-levels" target="_blank">1.10 Management of blood lipid levels</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#anti-thrombotic-therapy" target="_blank">1.11 Anti-thrombotic therapy</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#kidney-damage" target="_blank">1.12 Kidney damage</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#eye-damage" target="_blank">1.13 Eye damage</a></li> <li data-xf-list-type="ul"><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#nerve-damage" target="_blank">1.14 Nerve damage</a></li> </ul><p>And specifically, on dietary advice it states:</p><p></p><p><span style="font-size: 12px"><strong>1.2.1 Dietary advice</strong></span></p><p>1.2.1.1Provide individualised and ongoing nutritional advice from a healthcare professional with specific expertise and competencies in nutrition.</p><p></p><p>1.2.1.2Provide dietary advice in a form sensitive to the individual's needs, culture and beliefs, being sensitive to their willingness to change and the effects on their quality of life.</p><p></p><p>1.2.1.3Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to people with type 2 diabetes. Encourage high-fibre, low-glycaemic-index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low-fat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids.</p><p></p><p>1.2.1.4Integrate dietary advice with a personalised diabetes management plan, including other aspects of lifestyle modification, such as increasing physical activity and losing weight.</p><p></p><p>1.2.1.5Target, for people who are overweight, an initial body weight loss of 5–10%, while remembering that lesser degrees of weight loss may still be of benefit and that larger degrees of weight loss in the longer term will have advantageous metabolic impact.</p><p></p><p>1.2.1.6Individualise recommendations for carbohydrate and alcohol intake, and meal patterns. Reducing the risk of hypoglycaemia should be a particular aim for a person using insulin or an insulin secretagogue.</p><p></p><p>1.2.1.7Advise individuals that limited substitution of sucrose-containing foods for other carbohydrate in the meal plan is allowable, but that care should be taken to avoid excess energy intake.</p><p></p><p>1.2.1.8Discourage the use of foods marketed specifically for people with diabetes.</p><p></p><p>1.2.1.9When patients are admitted to hospital as inpatients or to any other institutions, implement a meal-planning system that provides consistency in the carbohydrate content of meals and snacks.</p><p></p><p>And then there's glucose monitoring. What NICE actually says versus what is regularly trotted out is somewhat different:</p><p></p><p><span style="font-size: 15px"><strong>1.4 Self-monitoring of plasma glucose</strong></span></p><p>1.4.1Offer self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education. Discuss its purpose and agree how it should be interpreted and acted upon.</p><p></p><p>1.4.2Self-monitoring of plasma glucose should be available:</p><p></p><ul> <li data-xf-list-type="ul">to those on insulin treatment<br /> <br /> </li> <li data-xf-list-type="ul">to those on oral glucose-lowering medications to provide information on hypoglycaemia<br /> <br /> </li> <li data-xf-list-type="ul">to assess changes in glucose control resulting from medications and lifestyle changes<br /> <br /> </li> <li data-xf-list-type="ul">to monitor changes during intercurrent illness<br /> <br /> </li> <li data-xf-list-type="ul">to ensure safety during activities, including driving.<br /> </li> </ul><p>1.4.3Assess at least annually and in a structured way:</p><p></p><ul> <li data-xf-list-type="ul">self-monitoring skills<br /> <br /> </li> <li data-xf-list-type="ul">the quality and appropriate frequency of testing<br /> <br /> </li> <li data-xf-list-type="ul">the use made of the results obtained<br /> <br /> </li> <li data-xf-list-type="ul">the impact on quality of life<br /> <br /> </li> <li data-xf-list-type="ul">the continued benefit<br /> <br /> </li> <li data-xf-list-type="ul">the equipment used.<br /> </li> </ul><p>1.4.4If self-monitoring is appropriate but blood glucose monitoring is unacceptable to the individual, discuss the use of urine glucose monitoring.</p><p></p><p>Then there's a whole section on ORally administered drugs, all is available for the UK from here:</p><p></p><p><a href="https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#lifestyle-managementnon-pharmacological-management" target="_blank">https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#lifestyle-managementnon-pharmacological-management</a></p><p></p><p>It's worth reading because what it states doesn't necessarily match with the experience that many people have had with regard to how they feel they have been treated.</p><p></p><p>Then when you consider that there are a vast array of guidelines, the majority of which GPs are expected to be familiar with, <a href="http://www.nice.org.uk/Guidance" target="_blank">http://www.nice.org.uk/Guidance</a>, you can understand why they may not be diabetes experts...</p></blockquote><p></p>
[QUOTE="tim2000s, post: 912946, member: 30007"] So... The NICE Guidance for T2 is: [LIST] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#patient-education']1.1 Patient education[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#lifestyle-managementnon-pharmacological-management']1.2 Lifestyle management/non-pharmacological management[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#glucose-control-levels']1.3 Glucose control levels[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#self-monitoring-of-plasma-glucose']1.4 Self-monitoring of plasma glucose[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#oral-glucose-control-therapies-1-metformin-insulin-secretagogues-and-acarbose']1.5 Oral glucose control therapies (1): metformin, insulin secretagogues and acarbose[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#oral-glucose-control-therapies-2-other-oral-agents-and-exenatide']1.6 Oral glucose control therapies (2): other oral agents and exenatide[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#glucose-control-insulin-therapy']1.7 Glucose control: insulin therapy[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#blood-pressure-therapy']1.8 Blood pressure therapy[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#cardiovascular-risk-estimation']1.9 Cardiovascular risk estimation[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#management-of-blood-lipid-levels']1.10 Management of blood lipid levels[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#anti-thrombotic-therapy']1.11 Anti-thrombotic therapy[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#kidney-damage']1.12 Kidney damage[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#eye-damage']1.13 Eye damage[/URL] [*][URL='https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#nerve-damage']1.14 Nerve damage[/URL] [/LIST] And specifically, on dietary advice it states: [SIZE=3][B]1.2.1 Dietary advice[/B][/SIZE] 1.2.1.1Provide individualised and ongoing nutritional advice from a healthcare professional with specific expertise and competencies in nutrition. 1.2.1.2Provide dietary advice in a form sensitive to the individual's needs, culture and beliefs, being sensitive to their willingness to change and the effects on their quality of life. 1.2.1.3Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to people with type 2 diabetes. Encourage high-fibre, low-glycaemic-index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low-fat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids. 1.2.1.4Integrate dietary advice with a personalised diabetes management plan, including other aspects of lifestyle modification, such as increasing physical activity and losing weight. 1.2.1.5Target, for people who are overweight, an initial body weight loss of 5–10%, while remembering that lesser degrees of weight loss may still be of benefit and that larger degrees of weight loss in the longer term will have advantageous metabolic impact. 1.2.1.6Individualise recommendations for carbohydrate and alcohol intake, and meal patterns. Reducing the risk of hypoglycaemia should be a particular aim for a person using insulin or an insulin secretagogue. 1.2.1.7Advise individuals that limited substitution of sucrose-containing foods for other carbohydrate in the meal plan is allowable, but that care should be taken to avoid excess energy intake. 1.2.1.8Discourage the use of foods marketed specifically for people with diabetes. 1.2.1.9When patients are admitted to hospital as inpatients or to any other institutions, implement a meal-planning system that provides consistency in the carbohydrate content of meals and snacks. And then there's glucose monitoring. What NICE actually says versus what is regularly trotted out is somewhat different: [SIZE=4][B]1.4 Self-monitoring of plasma glucose[/B][/SIZE] 1.4.1Offer self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education. Discuss its purpose and agree how it should be interpreted and acted upon. 1.4.2Self-monitoring of plasma glucose should be available: [LIST] [*]to those on insulin treatment [*]to those on oral glucose-lowering medications to provide information on hypoglycaemia [*]to assess changes in glucose control resulting from medications and lifestyle changes [*]to monitor changes during intercurrent illness [*]to ensure safety during activities, including driving. [/LIST] 1.4.3Assess at least annually and in a structured way: [LIST] [*]self-monitoring skills [*]the quality and appropriate frequency of testing [*]the use made of the results obtained [*]the impact on quality of life [*]the continued benefit [*]the equipment used. [/LIST] 1.4.4If self-monitoring is appropriate but blood glucose monitoring is unacceptable to the individual, discuss the use of urine glucose monitoring. Then there's a whole section on ORally administered drugs, all is available for the UK from here: [URL]https://www.nice.org.uk/guidance/cg87/chapter/1-Guidance#lifestyle-managementnon-pharmacological-management[/URL] It's worth reading because what it states doesn't necessarily match with the experience that many people have had with regard to how they feel they have been treated. Then when you consider that there are a vast array of guidelines, the majority of which GPs are expected to be familiar with, [URL]http://www.nice.org.uk/Guidance[/URL], you can understand why they may not be diabetes experts... [/QUOTE]
Verification
Post Reply
Home
Forums
Diabetes Discussion
Diabetes Discussions
Thoughts on why doctors often prescribe meds for T2 diabetes
Top
Bottom
Find support, ask questions and share your experiences. Ad free.
Join the community »
This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies.
Accept
Learn More.…