Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - August 2019

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of August 2019. This month there are two guidelines and one technology appraisal that impact upon primary care.

The Hypertension in adults: diagnosis and management guideline has been published. It covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively. This guideline updates and replaces NICE guideline CG127. It also updates and replaces the section on blood pressure management in the NICE guideline on type 2 diabetes in adults (NG28).

The Type 2 diabetes in adults: management guideline has been updated. It covers the care and management of type 2 diabetes in adults (aged 18 and over). It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications. The update removed the recommendations on blood pressure management which were updated and replaced by recommendations in the NICE guideline on hypertension in adults mentioned above.

The Dapagliflozin with insulin for treating type 1 diabetes technology appraisal has been published. Dapagliflozin with insulin is recommended as an option for treating type 1 diabetes in adults with a body mass index (BMI) of at least 27 kg/m2, when insulin alone does not provide adequate glycaemic control despite optimal insulin therapy, only if:

  • they are on insulin doses of more than 0.5 units/kg of body weight/day and
  • they have completed a structured education programme that is evidence based, quality assured, delivered by trained educators and includes information about diabetic ketoacidosis, such as:
    • how to recognise its risk factors, signs and symptoms
    • how and when to monitor blood ketone levels
    • what actions to take for elevated blood ketones
  • treatment is started and supervised by a consultant physician specialising in endocrinology and diabetes.

It is also recommended that haemoglobin A1c (HbA1c) levels are assessed after 6 months and regularly after this. Stop dapagliflozin if there has not been a sustained improvement in glycaemic control (that is, a fall in HbA1c level of at least 0.3%).

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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