Type 2 diabetes in adults: management. New NICE guidelines Dec 2015

[Southport GP]

I would like to draw everyone’s attention to a particular paragraph in the brand new NICE guidelines. These are produced to give an idea of ‘best practice’ to guide our health care professionals in their care for people with Type 2 diabetes. There has been much anticipation amongst us this time round and I want to share with you all a new emphasis on being ‘patient-centred’ which I find immensely cheering.

1.1 Individualised care

1.1.1 Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences, comorbidities, risks from polypharmacy, and their ability to benefit from long‑term interventions because of reduced life expectancy. Such an approach is especially important in the context of multimorbidity. Reassess the person's needs and circumstances at each review and think about whether to stop any medicines that are not effective. [new 2015]

1.3.3 Encourage high‑fibre, low‑glycaemic‑index sources of carbohydrate in the diet 1.3.6 Individualise recommendations for carbohydrate and alcohol intake

I know from reading your excellent forum over the years that many of you feel your personal preferences have been ignored. This important introductory paragraph gives me real hope of better collaboration between doctors, nurses, dieticians- and patients who at the end of the day probably are the best ‘experts’ on their own lives.

Please don’t be disappointed if things don’t change straight away. If any of you feel your voice is not heard in decision making then it’s possible you could make a polite reference to this introductory paragraph from NICE which enshrines your position in deciding the best way forward for your diabetic care

 

[Sid Bonkers]

Is "taking into account their personal preferences" even possible in a 10 minute consultation, not knocking doctors, just the system.

After saying hello, asking the patient how they are and what the problem is and doing any necessary preliminary tests how much time is left to individualise a treatment plan?

Its all very well saying these things but putting them into practice with the system that is in place now is just not possible imho.

Also I seem to remember that the previous NICE recommendations said something similar anyway, has anything really changed?

 

[Southport GP]

Good points Sid
I find the 10 minute thing very challenging too but I find working along with patients' goals is a lot more rewarding than just 'processing' patients.
In Diabetes taking notice of patients' preferences is in my opinion a far more efficient route to improving both diet, diabetic control and the doctor patient relationship.
Many other doctors are coming round to the fact that this is a far better way to practice medicine, and I have been charged by the Royal College Of GPs to try and 'nudge it along a bit' its got a name; Collaborative care
watch this space (and hope) !!

 

[AndBreathe]

Good points Sid
I find the 10 minute thing very challenging too but I find working along with patients' goals is a lot more rewarding than just 'processing' patients.
In Diabetes taking notice of patients' preferences is in my opinion a far more efficient route to improving both diet, diabetic control and the doctor patient relationship.
Many other doctors are coming round to the fact that this is a far better way to practice medicine, and I have been charged by the Royal College Of GPs to try and 'nudge it along a bit' its got a name; Collaborative care
watch this space (and hope) !!

At my appointment with the GP on diagnosis, I was instructed not to ask any questions because he had a lot to get through in ten minutes.

He was lucky to survive that.

Once I had explained it was my appointment, not his, we redrew battle lines.

He has moved to pastures on since then. I don't think that bit was all to do with me.

 

[Squire Fulwood]

I would like to draw everyone’s attention to a particular paragraph in the brand new NICE guidelines. These are produced to give an idea of ‘best practice’ to guide our health care professionals in their care for people with Type 2 diabetes. There has been much anticipation amongst us this time round and I want to share with you all a new emphasis on being ‘patient-centred’ which I find immensely cheering.


1.3.3 Encourage high‑fibre, low‑glycaemic‑index sources of carbohydrate in the diet 1.3.6 Individualise recommendations for carbohydrate and alcohol intake

Here is the rest of section 1.3.3.
1.3.3Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to adults 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. [2009]