Oral medication in type 2 diabetes: NICE guidance

A concise guide to practical use of oral medication for type 2 diabetes, in the light of the December 2015 NICE guideline.

In the past decade, a considerable and possibly confusing range of novel antidiabetic medications has become available for use in primary care. NICE has brought out guidance on type 2 diabetes in adults that includes an algorithm for glucose-lowering therapy (NG28).

Each oral treatment (except acarbose) can typically manage a reduction of the patient’s initial baseline HbA1c of about 11mmol/mol to 22mmol/mol and none is clearly superior to others. 

The results tend to be better in the beginning in patients with a high starting value. Further progress is limited for any agent after about six months of full-dose treatment. If there has not been a significant measurable improvement with a medication by that point, the patient can be regarded as a non-responder for this drug. 

Response to GLP-1 analogues, DPP-4 inhibitors and pioglitazone varies significantly between individuals, and there is a considerable zero-response rate (possibly up to 40% for exenatide).

NICE’s 2009 guidance stated:

Review pioglitazone and DPP-4 inhibitors after three to six months and stop them if the HbA1c has not been reduced by at least 5mmol/mol

Only continue GLP-1 mimetic therapy if there has been a reduction of at least 11mmol/mol in HbA1c and at least 3% of the initial body weight in six months

In its 2015 guidance, NICE relaxed the restriction on pio-glitazone and DPP-4 inhibitors. However, not all practitioners or practices have protocols in place to trial, review and potentially dismiss the use of the more modern oral antidiabetics, and this has significant cost implications. 

Full article here: http://www.gponline.com/oral-medication-type-2-diabetes-nice-guidance/diabetes/type-2-diabetes/article/1382509?

Eddie wrote:"Monitor the expected decline in health"

It's a dead cert for any diabetic following the very un-NICE guidelines.