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NICE advocates diabetes education

Every patient with type 2 diabetes should be offered structured education when he or she is diagnosed, the National Institute for Health and Clinical Excellence suggests in updated guidance, published in May 2008.

The new guideline on managing type 2 diabetes recommends that people with the condition, and their carers, should be made aware that structured education is an integral part of diabetes care, and this should take the form of a group education programme, provided locally.

NICE also provides advice on clinical matters, such as assessment of blood glucose control, blood-glucose-lowering therapy, blood pressure and cholesterol management, and neuropathic complications.

Self-monitoring of blood glucose should be offered to newly diagnosed patients only as part of a self-management education programme, NICE recommends.

Launch of the guideline coincides with a call from the charity Diabetes UK for better communication between healthcare professionals and people with type 2 diabetes.

The charity believes that some 650,000 people with type 2 diabetes are not taking the medicines prescribed to treat the condition. Many such patients do not understand why oral hypoglycaemic medicines have been prescribed or the long-term consequences of not taking them, Diabetes UK said in May 2008.

NICE on cholesterol

Guidance on identifying people most at risk of cardiovascular disease (CVD) and who should be treated with statins has been published this week by NICE. People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment, NICE recommends.

Before offering lipid modification therapy for primary prevention of CVD, other modifiable risk factors — such as smoking status, alcohol consumption, blood pressure and obesity — should be identified and managed if possible, NICE recommends.

For primary prevention, NICE says that simvastatin 40mg (or a statin of similar efficacy or acquisition cost) should be offered to adults over 40 years of age who have a 20 per cent or greater 10-year risk of developing CVD. Higher intensity statin therapy or treatment with fibrates or anion exchange resins should not be offered routinely.

Lipid modification therapy with simvastatin 40mg (or equivalent) should be offered as soon as possible in the presence of CVD (secondary prevention), the institute suggests.

NICE appraisal of drugs for ankylosing spondylitis and anaemia

This week NICE accepted adalimumab and etanercept, but not infliximab, for treatment of adults with severe active ankylosing spondylitis. The treatments are approved for patients with sustained active spinal disease (confirmed on two occasions at least 12 weeks apart) who have not benefited from therapy with two or more non-steroidal anti-inflammatory drugs taken at the maximum recommended dose for four weeks.

In a separate technology appraisal NICE has stipulated that erythropoietin analogues (epoetin alfa, epoetin beta and darbeopoetin alfa) should not be used routinely for managing anaemia induced by cancer treatment.

NICE says that erythropoietins can be used in combination with intravenous iron as an option for women receiving platinum-based chemotherapy for ovarian cancer who have symptomatic anaemia (haemoglobin 8g/100ml or lower), or for people who cannot be given blood transfusions and who have profound chemotherapy-related anaemia that is likely to impact on their survival.

Citation: The Pharmaceutical Journal URI: 10025515

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