New NICE guidelines.

[catherinecherub]

There is plenty to read, including dietary advice and self monitoring of blood glucose.
http://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#

• 1.1 Individualised care
• 1.2 Patient education
• 1.3 Dietary advice
• 1.4 Blood pressure management
• 1.5 Antiplatelet therapy
• 1.6 Blood glucose management
• 1.7 Managing complications

 

[Hiitsme]

I don't like the Self Monitoring advice. I think it should be encouraged for those who want to use it. It was only because I was self monitoring that I found out what some carbs were doing to my blood sugars and took action. The nurse tried to convince me that Weetabix was really good for me until she looked at my readings and agreed for me it wasn't good.

 

[Enclave]

I am very sorry to add this comment, and please remove if you want to censor this reply ...

How can any of the advice and guide lines be taken seriously when the dietary advice is still so wrong ... I will never trust a health Professional now due their advice I followed and lost my quality of life for so many years due to trusting their advice ...
As general rule I now never trust anyone who doesn't even know my name ... Even when it on a computer screen or scrap of paper in front of them

 

[Enclave]

I don't like the Self Monitoring advice. I think it should be encouraged for those who want to use it. It was only because I was self monitoring that I found out what some carbs were doing to my blood sugars and took action. The nurse tried to convince me that Weetabix was really good for me until she looked at my readings and agreed for me it wasn't good.

If they advise testing, more people will see how the dietary advice is wrong

 

[Oldvatr]

If they advise testing, more people will see how the dietary advice is wrong

Agreed, but NICE is only concerned with drugs and Big Pharma. They do now include some guidelines about diet and weight control, but as pointed out these are perhaps a little behind the times. They do not yet support 'eat to meter' testing which I think is where you were heading.... it is still difficult getting self monitoring support, These new guidelines seem to be less restrictive than they were, and now ask the physician to engage with the self monitoring process (which is new i think) But you only get strips if you are on certain drug therapies, or a Newbie. Or an out-and-out Hypo chondriac. I like the new additional advice to steer clear of foods specially made for Diabetics, and also the fact that they have come clean about cost being a major consideration when choosing drug therapies. (transparency I suppose). They also introduce the concept of the patient being able to turn down treatments that they are not happy with (<<the person's individual preferences and needs>>)

 

[SunnyExpat]

Agreed, but NICE is only concerned with drugs and Big Pharma. They do now include some guidelines about diet and weight control, but as pointed out these are perhaps a little behind the times. They do not yet support 'eat to meter' testing which I think is where you were heading.... it is still difficult getting self monitoring support, These new guidelines seem to be less restrictive than they were, and now ask the physician to engage with the self monitoring process (which is new i think) But you only get strips if you are on certain drug therapies, or a Newbie. Or an out-and-out Hypo chondriac. I like the new additional advice to steer clear of foods specially made for Diabetics, and also the fact that they have come clean about cost being a major consideration when choosing drug therapies. (transparency I suppose). They also introduce the concept of the patient being able to turn down treatments that they are not happy with (<<the person's individual preferences and needs>>)

The HCP won't force you to take drugs, it's always your choice .
I probably wouldn't be happy if pharmaceutical companies decided to stop manufacturing.
And I certainly wouldn't be as happy if we decided little pharma from a garden shed enterprise was better than a multi national with a proper production facility.

 

[Enclave]

They also introduce the concept of the patient being able to turn down treatments that they are not happy with (<<the person's individual preferences and needs>>)

When you do that .. they mark your record as being non compliant and then refuse to see you ... the wife has done that (Not for diabetes) and got the teeshirt

 

[Oldvatr]

The HCP won't force you to take drugs, it's always your choice .
I probably wouldn't be happy if pharmaceutical companies decided to stop manufacturing.
And I certainly wouldn't be as happy if we decided little pharma from a garden shed enterprise was better than a multi national with a proper production facility.

Do I detect a change of thread here? I take it you are worried about the recent move to introduce a bill in the UK to allow doctors to use unlicenced drugs and drugs that have gone 'off patent'. That attempt was fillibustered out, but may come back. And yes, we have a right to be worried, but it needs to be in its own thread. I use the term ;Big Pharma' because they have a monopoly through NICE, and can charge what they like while under patent. What the bill should have done is to allow other manufacturers to produce generic alternatives, but (and this is crucial) still require it to be under licence control and purchase through NICE as all our drugs are at the moment, not sneak them in by the back door bypassing NICE.

The HCP should not force drugs on us, but they substitute generics or offshore sources where it is cheaper, and we only find out when the instruction leaflet or the box gives the game away, Last week a patient went to high court to fight a health authority who went to court to force a medical procedure 'because there was danger to life'. the patient won, and has set a precedent that was beginning to become eroded. My GP threatened me with insulin, reciting the same mantra,. It is still my choice, but I may find my oral meds being withdrawn. or being forced to find another GP practice. As it happens I can show I am not insulin dependant, so can rightfully say Think Again.

 

[Oldvatr]

When you do that .. they mark your record as being non compliant and then refuse to see you ... the wife has done that (Not for diabetes) and got the teeshirt

In the Real World such things happen. But at least we have it in writing from the Comittee itself, and can take it up with higher authority if we need to. Even the Do IT or Die mantra has lost some of its power now,

 

[Daibell]

I wonder why NICE doesn't recommend Metformin SR if the standard version causes problems until later in the document? Why would NICE recommend a sulfonyl urea (Gliclazide) which will stimulate the pancreas to produce more insulin when many T2s have too much already hence the Metformin? I 'like' the way NICE skirts round the dietary advice on carbs. You can see that they spent a lot of time carefully wording it to avoid upsetting the HCPs fixated on lowering fat and salt and having carbs with every meal. Very sad that none of this is evidence-based and NICE is the one body supposedly using evidence-based advice. Glitazones are generally now considered unsafe if the evidence for that is reliable so why are NICE suggesting the use of them other than by rare exception?

 

[Oldvatr]

I wonder why NICE doesn't recommend Metformin SR if the standard version causes problems until later in the document? Why would NICE recommend a sulfonyl urea (Gliclazide) which will stimulate the pancreas to produce more insulin when many T2s have too much already hence the Metformin? I 'like' the way NICE skirts round the dietary advice on carbs. You can see that they spent a lot of time carefully wording it to avoid upsetting the HCPs fixated on lowering fat and salt having carbs with every meal. Very sad that none of this is evidence-based and NICE is the one body supposedly using evidence-based advice. Glitazones are generally now considered unsafe if the evidence for that is reliable so why are NICE suggesting the use of them other than by rare exception?

You raise a very good point here. I too was surprised to see the Glitazones still being recommended as a general issue drug,. I was on Actos for some time, but got taken off after my heart attack. I had previously been on Avandia, but in that case it got banned before I had my heart attack. The NICE recommendation is for Actos only , which is pioglitazone.

We must take into account that NICE is a comittee that meets infrequently. and in common with comittees eveywhere it takes time to formulate policies and then takes even longer to agree the wording. I am not surprised it is behind the times in regard to dietary matters since there have been major changes just in the last year (LCHF for instance). There is still a querty over high fat diets and T1D which seems to be being ignored at the moment. It may change things yet again. So, NiCE tends to be a dinosaur that takes a while to react to someone biting its tail. You suggest <<having carbs with every meal>> is a bad thing, but i would suggest that all meals will have carbs in them, its just a question of how many. else we die !

 

[CollieBoy]

I wonder why NICE doesn't recommend Metformin SR if the standard version causes problems until later in the document?

Might I suggest Price! Why bother to save patient sufering, if you can save a penny!

Why would NICE recommend a sulfonyl urea (Gliclazide) which will stimulate the pancreas to produce more insulin when many T2s have too much already hence the Metformin?

Some cannot cope with Metformin, but deal with Gliclazide relatively easily!

 

[SunnyExpat]

Might I suggest Price! Why bother to save patient sufering, if you can save a penny!

Some cannot cope with Metformin, but deal with Gliclazide relatively easily!

Why spend a fortune of NHS money, that could be much better used, on a course of treatment that is normally for life, simply because some patients initially have an upset stomach, which usually clears up after a short period.
I had no issue with metformin, and didn't particularly want the NHS to waste the taxpayers money.
If you do have an adverse reaction, fair enough.

Treatment tailored to suit the patient works both ways.

 

[Oldvatr]

Why spend a fortune of NHS money, that could be much better used, on a course of treatment that is normally for life, simply because some patients initially have an upset stomach, which usually clears up after a short period.
I had no issue with metformin, and didn't particularly want the NHS to waste the taxpayers money.
If you do have an adverse reaction, fair enough.

Treatment tailored to suit the patient works both ways.

As a T2D who is prescribed both Metformin (standard) and Gliclazide (also standard) I thank NICE for allowing me to get these on scrip. I was moved onto the modified release of both drugs this year, but returned to standard because I found the MR versions pushed my levels up in both cases, and I was unable to adjust either timing or dose to compensate. We all know NICE is price driven, and this year this has officially been declared as a criterion for drug selection

As regards the suitability of T2's being prescribed a sulphonylurea drug as second line, may i point out that many T2D;s end up on insulin therapy as a last resort when the beta cells run out, Gliclazide is classed as sulphonylurea, but it is second generation, and hopefully an improvement and possibly cheaper. When we consider the overhead costs of supporting insulin therapy compared to oral meds+diet, then I can see why NICE uses Gliclazide.

 

[SunnyExpat]

NICE should be, and has to be, price driven.

The taxpayer hasn't got bottomless pockets, and it's a message that needs to be very clear to the drug suppliers.
Increase the costs, and you will drive themselves out of the market.
Provide cost effective drugs, and your market share will increase.

 

[Oldvatr]

NICE should be, and has to be, price driven./,,,,/.
Provide cost effective drugs, and your market share will increase.

Unfortunately, in a monopoly market, and a sadly increasing but captive audience, then market share will still increase regardless of price. The only way that could change is to assist other manufacturers to bring generics to market.

 

[silky1]

I can't say I've read it all, nor have I read every response, however (and I appreciate this may go against the grain for some of you) - but since diagnosis, I've lived on a diet of fruit (Lots of people say fruit, noooooo), fruit juice with more ice than juice, no added fat omelettes (I bought one of these true non-stick pans) and gluten free pasta or rice - with a lean meat of gluten free breaded chicken - I know some people including my D nurse would have horrors at the amount of fruit I eat - yet my HbA1C has dropped from 106 to 44 in 3 months with 75% of my self readings being below 7.

As a newbie to Type II Diabetes I'm sure I've got loads to learn and will have many questions, but I'd far sooner learn it from my own ups and downs (I'm sure there will be times when I get it wrong) and the experience of others and how they manage their conditions rather than reading a book full of guidelines from an organisation with probably limited (if any) experience of TII Diabetes between them

Just my opinion

 

[SunnyExpat]

Unfortunately, in a monopoly market, and a sadly increasing but captive audience, then market share will still increase regardless of price. The only way that could change is to assist other manufacturers to bring generics to market.

It reaches a point were the cost of the drugs increases beyond the cost effective treatment of the patient.
So the patient will be prescribed, older, generic versions.

 

[dannyw]

Must admit, I agree with SunnyExpat here. The NHS is limited by cost constraints and not everyone will get the BEST treatment, medication available. Ideally, we would all be on CGM's and pumps ( or many more than are now ) but the money just isn't there. Hopefully, these super expensive drug companies will price themselves out of the market but places like the USA doesn't help as the huge costs are often swallowed up by insurance companies. The best, and by far the cheapest advice the NHS could promote is a LCHF diet. OK, it may not suit everyone and it will need adaptation but it is certainly the best tool in the armoury.

 

[zand]

NICE should be, and has to be, price driven.

The taxpayer hasn't got bottomless pockets, and it's a message that needs to be very clear to the drug suppliers.
Increase the costs, and you will drive themselves out of the market.
Provide cost effective drugs, and your market share will increase.

Yes I agree. I was perfectly happy to be given the cheaper older version of Metformin to try first, as it happens it suited me fine. Why waste money even if it is only pennies?