Consultation on Type 2 Diabetes: guideline consultation

[junemc153]

Anybody seen this - its on the NICE website.

http://www.nice.org.uk/guidance/indevelopment/gid-cgwave0612/consultation

Suggest you have a read of the consultaiton document. There is some interesting stuff in there which change the guidelines such as:-

Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes 6 unless the person:
 is on insulin or
 expriences symptomatic hypoglycaemia
or is on oral medication that may increase their risk of hypoglycaemia while driving or 10 operating machinery
or is pregnant, or is planning to become pregnant. For more information, see the NICE 12 guideline on diabetes in pregnancy. 13
Consider short-term self-monitoring for adults with type 2 diabetes who start treatment with 14 oral or intravenous corticosteroids.
[new 2015]

AND

1.3.5 Drug treatment
Offer standard-release metformin as the initial drug treatment for adults with type 2 diabetes.
new 2015]

If standard-release metformin is contraindicated or not tolerated, consider repaglinide as the initial drug treatment. Advise the person that if treatment with repaglinide does not control 20 HbA1c, then the person would need to change to pioglitazone, a sulfonylurea or a dipeptidyl peptidase-4 (DPP-4) inhibitor before adding another treatment
b (see First intensification of 22 drug treatment). [new 2015]

 

[graj0]

Anybody seen this - its on the NICE website.

It's sometimes very good to know which song book our GPs etc are singing from, I found the guidelines on cholesterol especially usefully because I realised that not only should I have had a risk assessment but when prescribing any drug, we have the right to say 'No thanks'.

 

[cold ethyl]

Be interesting to know if not offering slow release Metformin is a clinical decision or a cost one- have they got a job lot of repaglanide to shift?

 

[junemc153]

I found this through work at The Pulse today (GP news website). This is what the GP's think about it:-

http://www.pulsetoday.co.uk/clinica...min-alternatives-say-experts/20009139.article

 

[graj0]

Be interesting to know if not offering slow release Metformin is a clinical decision or a cost one- have they got a job lot of repaglanide to shift?

That is an interesting question and although I always knew it was more expensive because of the additional process required (wallpaper paste added) I would never have thought that buying it privately on t'internet would reveal such a huge difference. A 500mg tablet, 10p each for SR and 2p each for the ordinary stuff. Big markup for adding wallpaper paste (my description of the additive, although I seem to remember it was something similar).

 

[cold ethyl]

Just seems a big jump from Metformin to what I understand is a Glicazide type drug with its requirements to provide testing equipment for those driving or operating machinery as I understand it.

 

[graj0]

Metformin helps you deal with the insulin that's there and Gliclazide makes you produce more insulin if I've got it right. Metformin AKA Metfartin (an understatement IMHO) vs something that will help you gain some weight unless you reduce calories and increase exercise, carefully. Drugs that make you gain weight make the whole point of calculating your Basic Metabolic Rate a waste of time, because it will be wrong.