In 2008, NICE published a comprehensive guideline on the management of type 2 diabetes which took a patient-centred approach to care and updated recommendations on the management of blood glucose, blood pressure, lipids, thrombosis, renal function and retinopathy. A number of new and emerging therapies for blood glucose management were not included at the time and the recent publication of NICE Clinical guideline 87 provides valuable recommendations on when and where these drugs should be used in the care pathway. They give more options for healthcare professionals and their patients with type 2 diabetes at a time of ongoing change in management of the condition.
Individualising patient care with the new NICE guideline
Achieving effective lipid management in diabetes
People with type 2 diabetes are at an increased risk of cardiovascular disease (CVD), and management of diabetic dyslipidaemia is an essential part of diabetes management. The Joint British Societies’ 2 (JBS2) guidelines established the lipid targets of 4 mmol/L for total cholesterol and 2 mmol/L for LDL-cholesterol for people with type 2 diabetes and those with CVD. These lower targets for people with CVD were adopted by the NICE lipid modification guideline (CG67) in 2008, and the new NICE guideline for the management of type 2 diabetes continues this emphasis on lower lipid targets.
New drugs and where they fit in the treatment algorithm
In May 2009, NICE published recommendations on the use of newer agents for the control of blood glucose in type 2 diabetes. This guideline provides a partial update for NICE Clinical Guideline 66 on the management of type 2 diabetes that was published last year. These newer agents include the dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones (TZDs), the glucagon-like peptide-1 (GLP-1) mimetic exenatide and the long-acting insulin analogues (insulin detemir and insulin glargine).
New guideline provides a breath of fresh air that helps to individualise diabetes care
Type 2 diabetes patient with muscle aches on statin therapy
Type 2 diabetes patient without CVD, not achieving lipid targets
Previous coronary artery bypass graft (CABG) surgery
How well are we doing in lipid management?
Ensuring that patients are prescribed statin therapy tailored to individual risk
It is unsurprising that statins have become the most commonly prescribed drugs in many parts of the world, given the extraordinarily large and complete evidence base that supports their use. Their role in reducing cardiovascular (CV) events in both primary and secondary prevention is clear and predictable, with recent data extending their utility across most […]
Solving your cholesterol conundrums: Case studies in lipid management for primary care today
The benefits of lowering low-density lipoprotein (LDL) cholesterol with statin therapy for cardiovascular disease (CVD) prevention are well established. Recent guidelines from the National Institute for Health and Clinical Excellence (NICE) have emphasised the importance of achieving lower lipid levels, by adopting targets of 4 mmol/L for total cholesterol and 2 mmol/L for LDL cholesterol […]
Postprandial hyperglycaemia: red herring or red flag?
Several studies have suggested that postprandial rather than fasting hyperglycaemia may be a major determinant of cardiovascular risk. This article reviews the importance of postprandial hyperglycaemia and explores the benefits and risks of managing postprandial hyperglycaemia aggressively in order to prevent diabetes-related complications.
