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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

June CKS Update

Clinical Knowledge Summaries (CKS) has been updated in June 2009 for the following clinical areas:

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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HbA1c changes

The Department of Health has announced a phased transition in the way the HbA1c results are reported in the United Kingdom.

The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) has called for adoption of a global standard to allow easier comparison of results produced in different laboratories and countries.

Until 31 May 2011 results will be available using the existing percentage scale and the new millimoles per mol scale. After this date only the latter will be reported. DiabetesUK have also made a conversion tool available. Some common conversions are as follows:

  • 6.0% is equivalent to 42 mmol/mol
  • 6.5% is equivalent to 48 mmol/mol
  • 7.0% is equivalent to 53 mmol/mol
  • 7.5% is equivalent to 59 mmol/mol
  • 8.0% is equivalent to 64 mmol/mol
  • 9.0% is equivalent to 75 mmol/mol

Action: Clinicians should be aware of this transition. Patient education materials may need updating and it should be made clear that the higher number in the result does not necessarily indicate poor control.

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NRT cancer link?

PLoS ONE published the results of a study earlier this year that raised concerns about potential co-carcinogenic effects of nicotine in tobacco replacement therapies. The results have been reported in the general media (The Times) and according to Cancer Research UK some of these reports have been alarmist.

The original study assessed the effect of nicotine on cellular samples collected from the mouth or some head and neck cancers in a laboratory setting. Samples were collected from 75 individuals, some of whom already had cancer. The study found that nicotine up-regulated the activity of the FOXM1 gene which plays a role in several types of cancer.

These findings should not be considered conclusive and further work is required to assess the level of any risk posed by oral formulations of nicotine replacement therapy. It is also clear that smoking increases the risk of cancers, including mouth cancer and quitting will reduce this risk.

Action: Clinicians should be aware of this research; patients may need reassurance regarding their use of nicotine replacement products.

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