1 / 9

Type 2 diabetes Key slides 3; Management of blood glucose Lending our patients a hand

Type 2 diabetes Key slides 3; Management of blood glucose Lending our patients a hand. Glucose control Type 2 diabetes: the management of type 2 diabetes. NICE Clinical Guideline 66;May 2008. Measure HbA 1c every 2 to 6 months, until stable on unchanging therapy, then every 6 months

ashling
Télécharger la présentation

Type 2 diabetes Key slides 3; Management of blood glucose Lending our patients a hand

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Type 2 diabetesKey slides 3;Management of blood glucoseLending our patients a hand

  2. Glucose control Type 2 diabetes: the management of type 2 diabetes. NICE Clinical Guideline 66;May 2008 • Measure HbA1c every 2 to 6 months, until stable on unchanging therapy, • then every 6 months • Only offer self-monitoring of blood glucose as an integral part of self-management • education (discuss purpose, interpretation and how it should be acted upon) • see later for more details

  3. Algorithm for glucose control [1] Type 2 diabetes: the management of type 2 diabetes. NICE Clinical Guideline 66;May 2008 Continued on next slide…

  4. Algorithm for glucose control [2] Type 2 diabetes: the management of type 2 diabetes. NICE Clinical Guideline 66;May 2008 Continued from previous slide The guidance on glitazones, gliptins and exenatide will be updated in the NICE short clinical guideline ‘Newer agents for blood glucose in type 2 diabetes’, expected May 2009

  5. What is the guidance from NICE? NICE Clinical Guideline 66;May 2008 • Glitazones are third-line agents, as triple therapy with metformin and a SU if glycaemic control is insufficient (HbA1c>7.5%) • Or second-line agents (at HbA1c>6.5%), as dual therapy with metformin if hypoglycaemia on a SU a particular issue, or with a SU if metformin not tolerated/contraindicated • But there are safety issues; only pioglitazone▼ can be used with insulin The section covering glitazones, gliptins and exenatide will be updated in the NICE short clinical guideline ‘Newer agents for blood glucose in type 2 diabetes’, expected May 2009

  6. Do glitazones have POO data? CochraneRichter B, et al. Pioglitazone Cochrane Review 2006Richter B, et al. Rosiglitazone Cochrane Review 2007 Pioglitazone▼ • 22 RCTs (n=6,200 randomised to pioglitazone▼), included PROactive (average follow-up 34.5 months, primary endpoint: CV outcomes) Dormandy JA, et al. Lancet 2005;366:1279–1289 • Concluded: • no convincing evidence that patient-orientated outcomes (mortality, morbidity, adverse effects, costs, QoL) were positively influenced by pioglitazone ▼ • Oedema was significantly increased • Results of PROactive need confirmation; hypothesis generating Rosiglitazone • 18 RCTs (n=3,888 randomised to rosiglitazone), included ADOPT (average follow-up 4 years, primary endpoint: glycaemic control) Kahn SE, et al. N Engl J Med 2006;355:2427–2443 • Concluded: • No convincing evidence that patient-orientated outcomes (mortality, morbidity, adverse effects, costs, QoL) were positively influenced by rosiglitazone • Oedema was significantly increased • ADOPT indicated increased CV risk

  7. What did Drug Safety Update say?Drug Safety Update 2007;1 (5) • A Europe-wide safety and efficacy review found that the benefits of rosiglitazone • and pioglitazone▼ continue to outweigh the risks • However, the prescribing information has been updated to include warnings that: • - Rosiglitazone should be used in patients with ischaemic heart disease only after careful evaluation of every patient’s individual risk • - Rosiglitazone combined with insulin should be used only in exceptional cases and under close supervision

  8. Oral hypoglycaemics: Old vs. new drugsBolen S, et al. Ann Intern Med 2007;147:386–99 • Systematic review of 216 studies and 2 earlier systematic reviews of oral hypoglycaemics to January 2006 • Data on major clinical endpoints, eg CV mortality were limited, therefore inconclusive • But concluded that older agents have similar or superior effects to newer, more expensive agents on glycaemic control, lipids and other intermediate endpoints (body weight, BP, adverse effects, etc.) • Older agents: metformin, SU • Newer agents: glitazones, alpha-glucosidase inhibitors, eg acarbose and meglitinides

  9. Self-monitoring blood glucose Type 2 diabetes: the management of type 2 diabetes. NICE Clinical Guideline 66;May 2008 • Make available to: • Those on insulin • Those on oral medication to provide information on hypoglycaemia • Assess changes during medication or lifestyle changes, or illness • Ensure safety during activities, including driving • Assess at least annually in a structured way: • Self-monitoring skills • Quality and appropriate frequency of testing • The use made of results obtained • The impact on quality of life • The continued benefit • The equipment used

More Related