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Nice Diabetes Guidelines 2017

Nice To Look At Lowering Blood Pressure Targets In Guidance Overhaul

Nice To Look At Lowering Blood Pressure Targets In Guidance Overhaul

NICE to look at lowering blood pressure targets in guidance overhaul NICE has given the green light for a full update of its guidance on hypertension including the potential introduction of lower blood pressure targets that could see GPs treating many more people with antihypertensive drugs. Pulse previously revealed that NICE experts were considering new evidence on lowering blood pressure to a target of 120mmHg in high-risk patients , as part of a review of the current guidance published in 2011. Having concluded the review, NICE has now announced that it will carry out a full update of the guidelines and confirmed to Pulse that this will consider new evidence on blood pressure targets as part of revisions to the guidelines section on initiating and monitoring antihypertensive drug treatment, including blood pressure targets. The update will also take in new evidence on management of blood pressure in people with type 2 diabetes, previously covered in the condition-specific NICE guidelines on diabetes. Dr Terry McCormack, secretary of the British Hypertension Society and a GP in Whitby, North Yorkshire, was involved in the reappraisal of the guidelines in his role as NICE topic expert advisor. He told Pulse that the full update will include targets, fourth line therapy, lifestyle and diabetes andthat the review of blood pressure targets will specifically evaluate SPRINT. But he noted it was unlikely to reduce the target to as low as 120mmHg and would likely included recommendations on more intensive drug treatment, and adherence. Dr McCormack said: The actual achieved target was closer to 130mmHg. The average number of drugs in each arm were 2.8 and 1.8 which is more significant in my mind. He added: They also stopped drugs in the standard treatment arm, mostly diure Continue reading >>

Uk Nice Elevates Sglt2 Inhibitors In Diabetes Guidance

Uk Nice Elevates Sglt2 Inhibitors In Diabetes Guidance

UK NICE Elevates SGLT2 Inhibitors in Diabetes Guidance The UK National Institute of Health and Care Excellence (NICE) has revised its 2015 type 2 diabetes guidelines to feature the sodium-glucose cotransporter 2 (SGLT2) inhibitor class more prominently as a treatment option, while adding a warning about diabetic ketoacidosis (DKA) with the agents. The May 2017 revisions presented in a new algorithm represent a small but important change to the December 2015 guidelines, then the first major revision in 6 years. The December 2015 guidelines listed SGLT2 inhibitors as "reasonable options for second- and third-line therapy," following the September 2015 publication of the landmark EMPA-REG trial, which showed a reduction in cardiovascular death with the SGLT2 inhibitor empagliflozin (Jardiance, Boehringer Ingelheim/Lilly) compared with placebo in type 2 diabetes patients at high cardiovascular risk. But the way the old guideline was worded prompted one expert at the time to call the recommendation "a little bit guarded." Now the SGLT2 inhibitors are listed much more prominently as second-line therapy options, along with dipeptidyl peptidase-4 (DPP-4) inhibitors, pioglitazone, or sulfonylureas to be used on treatment intensification when HbA1c rises above 7.5% on metformin. They are also listed prominently for use in triple therapy once HbA1c rises above 7.5% on dual therapy. In addition, SGLT2 inhibitors can be considered as a first-line therapy option if metformin is contraindicated or cannot be tolerated and "a sulfonylurea or pioglitazone is not appropriate." At the same time, a new footnote has been added regarding reports of DKA in people taking any of the three currently available SGLT2 inhibitors canagliflozin (Invokana, Invokamet, Janssen), dapagliflozin (Farxiga, Continue reading >>

Idf Clinical Practice Recommendations For Managing Type 2 Diabetes In Primary Care

Idf Clinical Practice Recommendations For Managing Type 2 Diabetes In Primary Care

IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care - 2017 2 IDF Working Group Chair: Pablo Aschner, MD,MSc, Javeriana University and San Ignacio University Hospital, Bogota, Colombia. Core Contributors: Amanda Adler, MD, PhD, FRCP, Addenbrooke´s Hospital and National Institute for Health and Care Excellence(NICE), Cambridge, UK Cliff Bailey, PhD, FRCP(Edin), FRCPath, Aston University, Birmingham,UK Juliana CN Chan, MB ChB, MD, MRCP (UK), FRCP (Lond), FRCP (Edin), FRCP (Glasgow), FHKAM (Medicine), Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong, China. Stephen Colagiuri, MB, BS Honours Class II, FRACP, The Boden Institute, University of Sydney, Sydney, Australia Caroline Day, PhD, FRSB, MedEd UK and Aston University, Birmingham, UK Juan Jose Gagliardino, MD, Cenexa (Unlp-Conicet), La Plata, Argentina Lawrence A. Leiter, MD, FRCPC, FACP, FACE, FAHA, Clinical Nutrition and Risk Factor Modification Centre, Li Ka Shing Knowledge Institute at St. Michael’s Hospital and University of Toronto, Toronto, Canada Shaukat Sadikot, MD, President International Diabetes Federation (2016-2017), Diabetes India and Jaslok Hospital, Mumbai, India Nam Han Cho, MD, PhD, President-Elect International Diabetes Federation (2016-17), Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea Eugene Sobngwi, MD, MPhil, PhD, Central Hospital and University of Yaounde, Yaounde, Cameroon Acknowledgements Milena Garcia, MD, MSc, Javeriana University and San Ignacio University Hospital, Bogota, Colombia. Co-chaired the consensus meeting and contributed to the appraisal of the guidelines Chris Parkin - Medical writing support, CGParkin Communications, USA Martine V Continue reading >>

Type 2 Diabetes In Adults: Management Nice Guidelines

Type 2 Diabetes In Adults: Management Nice Guidelines

Type 2 diabetes in adults: management NICE Guidelines Type2 diabetes is a chronic metabolic condition characterised by insulin resistance (that is, the bodys inability to effectively use insulin) and insufficient pancreatic insulin production, resulting in high blood glucose levels (hyperglycaemia). Type2 diabetes is commonly associated with obesity, physical inactivity, raised blood pressure, disturbed blood lipid levels and a tendency to develop thrombosis, and therefore is recognised to have an increased cardiovascular risk. It is associated with longterm microvascular and macrovascular complications, together with reduced quality of life and life expectancy. National Institute for Health and Care Excellence, UK (NICE) has updated the guidelines on Type 2 diabetes in adults: managementin May 2017. followingare the major recommendations 1.1.1Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type2 diabetes, taking into account their personal preferences, comorbidities, risks from polypharmacy, and their ability to benefit from longterm interventions because of reduced life expectancy. Such an approach is especially important in the context of multimorbidity. Reassess the persons needs and circumstances at each review and think about whether to stop any medicines that are not effective. [new 2015] 1.1.2Take into account any disabilities, including visual impairment, when planning and delivering care for adults with type2 diabetes. [new 2015] 1.2.1Offer structured education to adults with type2 diabetes and/or their family members or carers (as appropriate) at and around the time of diagnosis, with annual reinforcement and review. Explain to people and their carers that structured education is an integral pa Continue reading >>

New Treatment Guidelines For Diabetes

New Treatment Guidelines For Diabetes

Authors: News Author: Miriam E Tucker; CME Author: Charles P. Vega, MD, FAAFP Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s) Family Physicians - maximum of 0.25 AAFP Prescribed credit(s) ABIM Diplomates - maximum of 0.25 ABIM MOC points Nurses - 0.25 ANCC Contact Hour(s) (0.25 contact hours are in the area of pharmacology) Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs) This article is intended for primary care physicians, endocrinologists, obstetrician-gynecologists, nurses, pharmacists, and other clinicians who care for individuals with diabetes. The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care. Upon completion of this activity, participants will be able to: Distinguish appropriate glycemic targets for patients with diabetes Assess best practices in the pharmacologic treatment of diabetes As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Disclosure: Miriam E. Tucker has disclosed no relevant financial relationships. Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships. Health Sciences Clinical Professor, Univer Continue reading >>

Nice Issue New Diabetes Guidelines

Nice Issue New Diabetes Guidelines

Everyone over 40 should be tested for diabetes, says health watchdog, the Daily Mail has announced. The Mail is one of several news sources to have highlighted major new guidelines that aim to reduce the impact of type 2 diabetes on people. The new guidelines have been published by the National Institute of Health and Clinical Excellence (NICE) and provide recommendations that are designed to: identify people at a potential high risk of developing the condition assess their individual risk with testing, and, if necessary offer lifestyle advice (such as advice on diet and exercise), to help prevent the condition in people who are at high risk, and advise on such things as dietary changes and increased physical activity Type 2 diabetes is a long-term and typically preventable condition that results in too much glucose (a type of sugar) in the blood. Symptoms include: going to the toilet a lot, especially at night There are a wide range of risk factors for type 2 diabetes, such as obesity and ethnicity and there are several serious complications, includingother cardiovascular diseases (such as heart attack and stroke). It can also lead to visual impairment, kidney failure and lower limb amputations due to foot ulcers. Preventing type 2 diabetes from occurring in the first place would have a significant positive impact in terms of public health and the life of millions of people in this country. The NICE guidelines report that diabetes currently affects almost 3 million people in the UK. Of these, 90% will have type 2 diabetes. The number of people with diabetes is estimated to rise to 5 million by 2025. A further 850,000 people in the UK are thought to have diabetes without knowing it. What do the new NICE guidelines on type 2 diabetes say? The NICE guidelines contain 20 Continue reading >>

Nice Guidelines Could Put 12 Million Uk Adults On Statins

Nice Guidelines Could Put 12 Million Uk Adults On Statins

NICE guidelines could put 12 million UK adults on statins NICE guidelines could put 12 million UK adults on statins BMJ 2017; 358 doi: (Published 01 August 2017) Cite this as: BMJ 2017;358:j3674 Almost all men over 60 and all women over 75 in England qualify for statin prescriptions under guidelines adopted by the National Institute for Health and Care Excellence (NICE) in 2014, a new analysis shows.1 Some 11.8 million people in England37% of adults aged 30 to 84exceed the threshold set by NICE for prescribing statins, the authors found. They said that most of these patients (9.8 million) are healthy, with no history of cardiovascular events, and are eligible for treatment simply because they exceed the risk threshold set by NICE: a 10% risk of experiencing such an event in the next 10 years. Even some people with no risk factors at all are part of this group by virtue of their age. Nearly all men exceed the 10% threshold by age 65, and all women do so by age 70, even if they are non-smokers of normal weight with Continue reading >>

Nice Updates Guidance On Type 2 Diabetes Prevention

Nice Updates Guidance On Type 2 Diabetes Prevention

NICE updates guidance on type 2 diabetes prevention NICE has published an update to NICE Public Health Guideline (PH) 38 on Type 2 diabetes: prevention in people at high risk . In the UK, 3.9 million people live with diabetes;90% of whom will have type 2 diabetes.People with type 2 diabetes have an increased risk of cardiovascular disease, including coronary heart disease and stroke, and they are more likely to have high blood pressure. Type 2 diabetes occurs more frequently in people who are overweight or obese and the risk increases with body weight. In September 2017, NICEreviewed the evidence for intensive lifestyle-change programmes and evidence for metformin for people at risk of type 2 diabetes, and implemented the following changes: recommendation 1.5 on matching interventions to risk and recommendation 1.6 on reassessing risk were added recommendation 1.19.1 on when to offer metformin in the context of lifestyle change was updated. The areas covered by the recommendations in PH38 include: Continue reading >>

Nice Updates Type 2 Guidelines To Reflect New Advice On Drug Treatments

Nice Updates Type 2 Guidelines To Reflect New Advice On Drug Treatments

NICE updates type 2 guidelines to reflect new advice on drug treatments NICE updates type 2 guidelines to reflect new advice on drug treatments British Medical Association warns NHS is a ticking time bomb 11 May 2017 The National Institute of Care and Excellence (NICE) has updated its guidelines about drug treatments for people with type 2 diabetes. This new update features information about sodium-glucose cotransporter 2 (SGLT-2) inhibitors, which "may be appropriate for some adults with type 2 diabetes if metformin is contraindicated or not tolerated". NICE has also updated its algorithm for blood glucose-lowering therapy in adults with type 2 diabetes. The algorithm now states that an SGLT2 inhibitor in combination with insulin with or without other anti-diabetic drugs is an option for treatment. NICE said the type 2 diabetes guidelines were revised because of the "availability of new evidence and several key developments" regarding drug treatments. Information has also been added following safety concerns over a number of drugs used to treat type 2 diabetes. These concerns followed "new evidence on new dipeptidyl peptidase 4 (DPP 4) inhibitors and glucagon like peptide 1 (GLP 1) receptor agonists, new indications and licensed combinations for licensed class members and the potential impact of drugs coming off patent on health economic issues". This new evidence has prompted updates in the following areas: managing blood glucose levels , antiplatelet therapy and erectile dysfunction . Regarding antiplatelet therapy, which helps to prevent arterial clots, NICE has updated its warning on safety issues to the off label use of antiplatelet therapy ( aspirin and clopidogrel). The new advice also covers the care and management of type 2 diabetes in adults. It focuses on p Continue reading >>

Nice Type 2 Diabetes Guideline

Nice Type 2 Diabetes Guideline

Treatment with a single non-insulin blood glucose lowering therapy (monotherapy) Treatment with two non-insulin blood glucose lowering therapies in combination (dual therapy) Treatment with either three non-insulin blood glucose lowering therapies in combination (triple therapy) or any treatment combination containing insulin Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences, comorbidities, risks from polypharmacy, and their ability to benefit from long-term interventions because of reduced life expectancy. Such an approach is especially important in the context of multimorbidity. Reassess the person's needs and circumstances at each review and think about whether to stop any medicines that are not effective Take into account any disabilities, including visual impairment, when planning and delivering care for adults with type 2 diabetes Offer structured education to adults with type 2 diabetes and/or their family members or carers (as appropriate) at and around the time of diagnosis, with annual reinforcement and review. Explain to people and their carers that structured education is an integral part of diabetes care Ensure that any structured education programme for adults with type 2 diabetes includes the following components: it is evidence-based, and suits the needs of the person it has specific aims and learning objectives, and supports the person and their family members and carers in developing attitudes, beliefs, knowledge and skills to self-manage diabetes it has a structured curriculum that is theory-driven, evidence-based and resource-effective, has supporting materials, and is written down it is delivered by trained educators who ha Continue reading >>

Nice Updates Type 2 Diabetes Guidance

Nice Updates Type 2 Diabetes Guidance

Changes have been made to the guidance of type 2 diabetes management by the National Institute of Care and Excellence (NICE). The organisation has added text onsodiumglucose cotransporter 2 (SGLT-2) inhibitors to the section on initial drug treatment . Thealgorithm for blood glucose lowering therapy in adults with type 2 diabetes has also been revised to allow for a footnote with links to relevant NICE guidance on SGLT-2 inhibitors. New information on SGLT-2 inhibitors has also been added to the box on action to take if metformin is contraindicated or not tolerated. Theupdated guideline also includes new recommendations on individualised care , managing blood glucose levels , anti platelet therapy and managing complications . NICE said the reason the advice had been updated was because since the publication of the 2009 guideline, availability of new evidence and several key developments have prompted an update in the following areas: managing blood glucose levels, antiplatelet therapy and erectile dysfunction. The organisation said the reasons included safety concerns surrounding some blood glucose lowering medicines, new evidence on new dipeptidyl peptidase4 (DPP4) inhibitors and glucagonlike peptide1 (GLP1) receptor agonists, new indications and licensed combinations for licensed class members and the potential impact of drugs coming off patent on healtheconomic issues. Now, because there evidence and safety issues relating to the offlabel use of antiplatelet therapy (aspirin and clopidogrel) in the primary prevention of cardiovascular disease has been found this motivated an update of this review. The newly updated guidelinesupdates and replaces NICE guideline CG87, NICE guideline CG66, NICE technology appraisal guidance 248 and NICE technology appraisal guidance 20 Continue reading >>

Diabetes In Pregnancy (nice Clinical Guideline 3)

Diabetes In Pregnancy (nice Clinical Guideline 3)

This guideline was produced by the National Collaborating Centre for Women’s and Children’s Health (NCC-WCH) on behalf of the National Institute of Health and Care Excellence (NICE). The guideline focuses on areas where additional or different care should be offered to women with diabetes and their newborn babies. Where the evidence supports it, the guideline makes separate recommendations for women with pre‑existing diabetes and women with gestational diabetes. Continue reading >>

Management Of Type 2 Diabetes (nice Guideline)

Management Of Type 2 Diabetes (nice Guideline)

NICE recommends that care be tailored to the needs and circumstances of the individual patient, taking into account their personal preferences, comorbidities, risks from polypharmacy, and ability to benefit from long-term interventions. Download a pdf version of the above chart. Adapted from: NICE Clinical Guideline 28 (December 2015; updated July 2016) - Type 2 diabetes in adults: management. KEYWORDS: Canagliflozin | Dapagliflozin | DPP4 inhibitor | Empagliflozin | Exenatide | Glitazones | GLP-1 agonists | Insulin detemir | Insulin glargine | Insulin secretagogues | Linagliptin | Liraglutide | Lixisenatide | Metformin | Monitoring | Pioglitazone | Repaglinide | Saxagliptin | SGLT2 inhibitors | Sitagliptin | Sulfonylureas | Vildagliptin Continue reading >>

Updated Guidelines On Diabetic Foot Problems, Published By Nice

Updated Guidelines On Diabetic Foot Problems, Published By Nice

Updated guidelines on diabetic foot problems, published by NICE Updated guidelines on diabetic foot problems, published by NICE The new guidelines on diabetic foot problems have now been published on the NICE website . This guideline covers preventing and managing foot problems in children, young people and adults with diabetes. The guideline aims to reduce variation in practice. This variation in practice results from a range of factors including the different levels of organisation of care for people with diabetes and diabetic foot problems. This variability depends on geography, individual trusts, individual specialties (such as the organisation and access of the diabetic foot care services) and availability of healthcare professionals with expertise in the management of diabetic foot problems. The implementation of foot care screening programmes is still varied across the UK, and there is currently a lack of guidance on foot screening strategies aimed at children and young people with diabetes. There is a need for a comprehensive guideline on foot care for people with diabetes that addresses all NHS settings. Continue reading >>

Acp Guidance Statement On Hba | Annals Of Internal Medicine | American College Of Physicians

Acp Guidance Statement On Hba | Annals Of Internal Medicine | American College Of Physicians

Author, Article, and Disclosure Information This article was published at Annals.org on 6 March 2018. * This paper, authored by Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Devan Kansagara, MD, MCR; Carrie Horwitch, MD, MPH; Michael J. Barry, MD; and Mary Ann Forciea, MD, was developed for the Clinical Guidelines Committee of the American College of Physicians. Individuals who served on the Clinical Guidelines Committee from initiation of the project until its approval were Mary Ann Forciea, MD (Chair); Nick Fitterman, MD; Kate Balzer, MSW; Michael J. Barry, MD; Cynthia Boyd, MD, MPH; Carrie Horwitch, MD, MPH; Linda L. Humphrey, MD, MPH; Alfonso Iorio, MD, PhD; Devan Kansagara, MD, MCR; Jennifer Lin, MD, MCR; Scott Manaker, MD, PhD; Michael Maroto, JD, MBA; Robert McLean, MD; Reem Mustafa, MD, PhD, MPH; Janice Tufte; Sandeep Vijan, MD, MS; and Timothy J. Wilt, MD, MPH. Approved by the ACP Board of Regents on 26 March 2017. Author (participated in discussion and voting). Nonauthor contributor (participated in discussion but excluded from voting). American College of Physicians, Philadelphia, Pennsylvania (A.Q.) Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.) Oregon Health & Science University and Veterans Affairs Medical Center, Portland, Oregon (D.K.) Virginia Mason Medical Center, Seattle, Washington (C.H.) Massachusetts General Hospital, Boston, Massachusetts (M.J.B.) University of Pennsylvania Health System, Philadelphia, Pennsylvania (M.A.F.) Note: Guidance statements are guides only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP guidance statements are considered automatically withdrawn or invalid 5 years after publication, or once an update h Continue reading >>

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