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    Oral medication in type 2 diabetes: NICE guidance

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    graham64
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    Oral medication in type 2 diabetes: NICE guidance

    Post by graham64 on Sun Feb 14 2016, 21:51

    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?


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    chris c
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    Re: Oral medication in type 2 diabetes: NICE guidance

    Post by chris c on Mon Feb 15 2016, 17:55

    Oh I purely HATE these algorithms. They originated in the Texas cattle industry. Last time I looked at the diabetes advice it contained the line "Monitor the expected decline in health", then you could increase or add more drugs whenever the A1c went over 8. Which it obviously did while following the recommended high carb low fat diet.
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    Eddie
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    Re: Oral medication in type 2 diabetes: NICE guidance

    Post by Eddie on Mon Feb 15 2016, 19:47

    "Monitor the expected decline in health"

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


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    Type two diabetic-low carb diet (50 carbs per day) and two 500mg Metformin pills per day. Apart from diagnosis HbA1c almost 12-all HbA1c results none diabetic. For over eight years my diabetes medication has not changed. My weight has remained stable, I have suffered no ill effects from my diet whatsoever. Every blood test has proved, I took the right road to my diabetic salvation. For almost seven years, I have asked medical professionals and naysayers, how do I maintain non diabetic BG levels on two Metformin other than low carb ? The silence has been deafening !
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    chris c
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    Re: Oral medication in type 2 diabetes: NICE guidance

    Post by chris c on Thu Feb 18 2016, 19:17

    @Eddie wrote:"Monitor the expected decline in health"

    It's a dead cert for any diabetic following the very un-NICE guidelines.
    Scary how people intelligent enough to become doctors fail to see what's staring them in the face . . .

      Current date/time is Fri Jul 21 2017, 09:34