Prescribing Advice for GPs

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NICE Guidance - February 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of February 2020. This month there are four guidelines, two technology appraisals and two antimicrobial guidelines that impact upon primary care.

The Asthma: diagnosis, monitoring and chronic asthma management guideline has been updated. It covers diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks. It does not cover managing severe asthma or acute asthma attacks. The advice on self-management for children and young people with deteriorating asthma control has been updated.

The Epilepsies: diagnosis and management guideline has been updated. It covers covers diagnosing, treating and managing epilepsy and seizures in children, young people and adults in primary and secondary care. The update has amended recommendations in line with the MHRA guidance on valproate use by women and girls.

The Bipolar disorder: assessment and management guideline has been updated. It covers recognising, assessing and treating bipolar disorder (formerly known as manic depression) in children, young people and adults. The update has amended recommendations in line with the MHRA guidance on valproate use by women and girls.

The Antenatal and postnatal mental health guideline has been updated. It covers recognising, assessing and treating mental health problems in women who are planning to have a baby, are pregnant, or have had a baby or been pregnant in the past year. The update has amended recommendations in line with the MHRA guidance on valproate use by women and girls.

The Dapagliflozin with insulin for treating type 1 diabetes technology appraisal has been published. It recommends dapagliflozin with insulin as an option for treating type 1 diabetes in adults with a 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 0.5 units/kg of body weight/day or more 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 and
  • treatment is started and supervised by a consultant physician specialising in endocrinology and diabetes treatment, and haemoglobin A1c (HbA1c) levels are assessed after 6 months and regularly after this.
  • It is also recommended that the dapagliflozin is stopped if there has not been a sustained improvement in glycaemic control (that is, a fall in HbA1c level of about 0.3% or 3 mmol/mol).

The Sotagliflozin with insulin for treating type 1 diabetes technology appraisal has been published. It recommends sotagliflozin with insulin as an option for treating type 1 diabetes in adults with a BMI of at least 27 kg/m2, when insulin alone does not provide adequate glycaemic control despite optimal insulin therapy, only if:

  • sotagliflozin is given as one 200 mg tablet daily
  • they are on insulin doses of 0.5 units/kg of body weight/day or more 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 and
  • treatment is started and supervised by a consultant physician specialising in endocrinology and diabetes treatment, and haemoglobin A1c (HbA1c) levels are assessed after 6 months and regularly after this.
  • It is also recommended that the sotagliflozin is stopped if there has not been a sustained improvement in glycaemic control (that is, a fall in HbA1c level of about 0.3% or 3 mmol/mol).

The Leg ulcer infection antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for adults with leg ulcer infection. It aims to optimise antibiotic use and reduce antibiotic resistance.

The Impetigo antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for adults, young people and children aged 72 hours and over with impetigo. It aims to optimise antibiotic use and reduce antibiotic resistance.

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

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