Forthcoming Drug Recommendations for Type 2 Diabetics from NICE

Dr Katharine Morrison, at The Diabetes Diet Blog, is a practising GP and a senior partner in an Ayrshire medical practice. Following the diagnosis of her son with type 1 diabetes 10 years ago, she has worked extensively with diabetics (both type 1 and type 2) to help them achieve good blood sugar control – a vital component in good health and longevity. She is also the author and co-author of a number of medical papers on diabetes and the strategies that can help minimise its impact on health.

She has just put this article on her blog, which may interest readers ...

Forthcoming Drug Recommendations for Type 2 Diabetics from NICE

" NICE have some drug recommendations to make for diabetics in their forthcoming guidelines later this year. It can be seen that NICE are heavily influenced by drug costs. So what could these new guidelines mean for you?

The blood pressure recommendations have scarcely changed but the use of Repaglinide first or second line for blood sugar control is a change from previously. Blood sugar targets have tightened up a bit and structured education is expected for insulin users. Cheaper, older insulins are favoured. Blood sugar testing is being rationed considerably. Aspirin is out of favour but drugs for erectile dysfunction are in. Erythromycin is being adopted for the very difficult to manage problem of gastroparesis.

The medications you will need to take to improve your life with diabetes will depend on many factors. Primarily, what do you want a medication to do for you?

The answer to this will depend on how well you are managing lifestyle changes, how long you have had the condition, the presence of any complications, and how tight you want glycaemic control, blood pressure and lipids to be. The targets need to be individualised to you, and this can be done by becoming more informed about your condition and discussing it with other health care providers and people with diabetes. We discuss these factors in our book, the Diabetes Diet, and I will be updating you on some of the new recommendations in further articles.

This article covers the changes to blood pressure medications, glycaemic targets and drugs to control blood sugar, self-monitoring of blood sugar, insulin initiation and the management of complications. "

Do go over and continue reading http://diabetesdietblog.com/2015/08/12/forthcoming-drug-recommendations-for-type-2-diabetics-from-nice/

All the best Jan

There is a little link at the bottom of the page for "Low Carb Myths Busted" which is also worth a look.

I'd like to know how they got this stat:

"Self monitoring produced only a 0.22% reduction in hbaic. It was considered by NICE to be not helpful for most people with type two diabetes though more hypos were detected with it."

mo1905 wrote:I'd like to know how they got this stat:

"Self monitoring produced only a 0.22% reduction in hbaic. It was considered by NICE to be not helpful for most people with type two diabetes though more hypos were detected with it."

They probably made it up as they do many other things. It is certainly convenient if you don't want to pay for strips.

A phrase I have come across quite a lot lately is "Evidence based advice". It seems a novel concept to some writers.

mo1905 wrote:I'd like to know how they got this stat:

"Self monitoring produced only a 0.22% reduction in hbaic. It was considered by NICE to be not helpful for most people with type two diabetes though more hypos were detected with it."

Andrew Farmer is to blame. If you read between the lines (he did other studies too) the patients were specifically told NOT to change anything as a result of their testing, which completely and abjectly misses the point.

This was obviously the result he was paid to produce.

Meanwhile Andy Karter was paid to find out whether or not testing was cost-effective, and came to the opposite conclusion (Kaiser Permanente are NOT noted for spending a cent on healthcare when they don't have to)

The interesting fact that is not noticed in the Farmer paper is that testing or not, the patients had an A1c around 7.5%. This clearly shows that the diet they were exhorted to "maintain adherence to" was crap.

I note that the Andrew Farmer paper, linked to above, was accepted in June 2007, which means the work was probably done in or about 2005/6.  It's hard to imagine that any (or certainly many) of us would have known how to respond correctly to monitoring results back then, or that the internet would have been very forthcoming with beneficial suggestions.
So, even though there were three groups,
1.  who did nothing
2.  who monitored and went to their GP for interpretation
3.  who monitored, were trained in interpretation and maintaining a healthy lifestyle,
What would they have actually changed as a result of a "HI" on their meter?

I remember the words of my husband's GP, "Don't go above 10 or below 4, ha ha.".  So we know what Group two will have been told, "that's excellent, keep eating the whole grains" and Group three will have been trained to say , "I'm doing really well, must have a brisk walk to the bread shop".

What a load of outdated 5h1t.
Sally

Actually the Test Test Test advice goes back to at least 2002. In those days we were Real Men and used newsgroups where this was the first advice every newbie was given. It was posted on at least half a dozen other websites. In all this time it has NEVER been subjected to an RCT and remains "just anecdotal".

Meanwhile the instructions given by doctors and especially nurses continue to disappoint, including a nurse at Joslin who said words to the effect that "if you test after eating, of course your BG will be high, you're diabetic. You should wait until it goes back down again before you test!"

And the all time low

"If you test your blood you'll damage your fingers, then you won't be able to read braille WHEN you go blind!"

Quite astonishing.

chris c wrote:Meanwhile the instructions given by doctors and especially nurses continue to disappoint, including a nurse at Joslin who said words to the effect that "if you test after eating, of course your BG will be high, you're diabetic. You should wait until it goes back down again before you test!"

And the all time low

"If you test your blood you'll damage your fingers, then you won't be able to read braille WHEN you go blind!"

Quite astonishing.

I posted this study from the AADE which concluded that T2s given a structured education could benefit from SMBG, but we don't want that do we the damage to your fingers, the stress and depression from worrying about high numbers and the inability to read braille when we go blind, and god forbid you might find out the effects of the eatwell plate on your blood sugars 

"Richard Bernstein. Didn't he write West Side Story?"