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    NICE Draft guidelines "bonkers"

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    Eddie
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    NICE Draft guidelines "bonkers"

    Post by Eddie on Tue Feb 10 2015, 15:40

    Primary care experts are urging NICE to overhaul draft guidelines on type 2 diabetes, claiming recommendations to use the drug repaglinide are ‘bonkers’ and risk setting care back a decade, Pulse has learned.

    The experts said the recommended treatment algorithm for glycaemic control was ‘nonsensical’, drawing particular attention to the promotion of the insulin secretagogue repaglinide – which primary care has ‘little understanding of’ because it is rarely prescribed.

    The draft guidelines still recommend metformin as first-line initial therapy, but have demoted sulfonylureas from their position as a second-line or alternative option to metformin over concerns about their associated risks of hypoglycaemia.

    They now propose repaglinide as an alternative first-line therapy in people who cannot tolerate metformin. But Professor Roger Gadsby, GPSI in diabetes and principle teaching fellow at the University of Warwick, told Pulse the treatment algorithm was considered ‘bonkers’ by diabetes experts.

    Professor Gadsby said: ‘Many experts in diabetes have labelled part of this draft guidance as “bonkers”… A particular area of concern is the recommendation that in the 15% or so who cannot tolerate metformin as initial monotherapy for glycaemic control the drug repaglinide should be used.’

    More on this new Pulse story here http://www.pulsetoday.co.uk/20009139.article#.VNoOJNUgiiw


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    Andy12345
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    Re: NICE Draft guidelines "bonkers"

    Post by Andy12345 on Tue Feb 10 2015, 15:48

    which came first.....the Bonkers or the Sid?
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    Two Collies
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    Re: NICE Draft guidelines "bonkers"

    Post by Two Collies on Tue Feb 10 2015, 19:11

    Nah, he can't, heard his ED trumps his narcissism affraid
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    mo1905
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    Re: NICE Draft guidelines "bonkers"

    Post by mo1905 on Tue Feb 10 2015, 23:28

    There are quite a few that initially struggle with metformin but surely the SR version should be 2nd ?


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    Re: NICE Draft guidelines "bonkers"

    Post by Two Collies on Wed Feb 11 2015, 09:40

    @mo1905 wrote:There are quite a few that initially struggle with metformin but surely the SR version should be 2nd ?
    From the Electronic Drug Tariff

    Repaglinide 1mg tablets 90 £10.29
    Repaglinide 2mg tablets 90 £5.86
    Repaglinide 500microgram tablets 90 £9.12
    dose start 1/2-1 mg max dose 16 mg

    Metformin 500mg modified-release tablets 56 £5.32
    Metformin 750mg modified-release tablets 56 £6.40
    Metformin 1g modified-release tablets 56 £8.52
    so ~max dose =#32p-96p/day

    So probably cheaper on Repaglinide than Metformin so THAT will be the NICE driver affraid


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    Re: NICE Draft guidelines "bonkers"

    Post by Two Collies on Wed Feb 11 2015, 09:44

    Check out the pulse comments:
    Readers' comments (7)

    Anonymous

    Anonymous | GP Partner | 09 February 2015 10:56am

    No, NICE is a "laughing stock"! staffed by "theoreticians" ie experts who know all the answers but have never actually seen a real patient and think that clinical medicine is practised in a highly controlled environment.

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    Anonymous

    Anonymous | GP Partner | 09 February 2015 11:21am

    NICE a laughing stock....who would have thunk it!

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    Vinci Ho

    Vinci Ho | GP Partner | 09 February 2015 2:08pm

    If I am correct , Repaglinide is essentially a SU but was first marketed to target post prandial hyperglycaemia . Side effects like hypoglycaemia and weight gain are still concerns. Difficult to understand the mentality of these guys in NICE. Replace one SU with another SU.......

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    Anonymous

    Anonymous | Sessional/Locum GP | 09 February 2015 5:32pm

    Not sure the headline is completely accurate.
    It suggests NICE is not already a laughing stock?

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    Anonymous

    Anonymous | GP Partner | 10 February 2015 8:12am

    No
    Idea
    Concerning
    Everything

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    Mustafa Rahim | Private GP | 10 February 2015 1:21pm

    NICE should promote weight reducing SPLTP2 inhibitors Dapaglizone which causes weight loss, instead of replaglinide with on demand suphonyurea stimulating Insulin release rapid onset action,short duration of activity but can cause weight gain

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    Anjan Bose | GP Partner | 10 February 2015 1:43pm

    With due respect to all
    although i will not comment about the above points but we are missing here a point specially those category who cannot have sulphonylureas for excessive monitoring needs
    i have always placed PPRs far above the glitazones and have achieved good results
    lets not suddenly become too modern pharmacotherapeutic orientated
    as far as metformin is considered-it is the best drug and the only shown to reduce cardiovascular events
    the primary care should wake up and start considering tailor made therapies and not just blindly follow guidelines
    remember Sir Charles Darwin-"NO TWO INDIVIDUALS ARE ALIKE"

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