Focus on glycaemic management: A veritable feast or a dog's dinner?

Abstract

The latest National Institute for Health and Clinical Excellence guideline was published in May 2008. Despite the availability of several new pharmacological interventions for the treatment of type 2 diabetes since the previous guidance in 2002, the incretin mimetic exenatide is the only newer agent included in the new guideline. Herein, the key priorities around glycaemic management are reviewed and consideration is given to whether the guideline is likely to have major implications for management of people with type 2 diabetes. Br J Diabetes Vasc Dis 2008; 8: 191—194

Keywords

exenatide guidelines NICE thiazolidinediones type 2 diabetes

Get full access to this article

View all access options for this article.

References

National Institute for Health and Clinical Excellence. Type 2 Diabetes (Update). National clinical guideline for the management in primary and secondary care. National Institute for Health and Clinical Excellence, expected date of publication 2008 .

National Institute for Health and Clinical Excellence. Guidance on the use of long-acting insulin analogues for the treatment of diabetes-insulin glargine. National Institute for Health and Clinical Excellence, NICE technology appraisal guidance no. 53 (2002).

National Institute for Health and Clinical Excellence. Guidance on the use of patient-education models for diabetes. National Institute for Health and Clinical Excellence, NICE technology appraisal guidance no. 60 (2003).

National Institute for Health and Clinical Excellence. Guidance on the use of glitazones for the treatment of type 2 diabetes. NICE technology appraisal technology no. 63 (2003).

National Institute for Health and Clinical Excellence. Cardiovascular risk assessment: the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. National Institute for Health and Clinical Excellence, expected date of publication 2008.

National Institute for Health and Clinical Excellence. Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period. National Institute for Health and Clinical Excellence, expected date of publication 2008 .

National Institute for Health and Clinical Excellence. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children (CG43). UK: London: National Institute for Health and Clinical Excellence, 2006.

National Institute for Health and Clinical Excellence. Hypertension: management of hypertension in adults in primary care (partial update of CG18) CG34. UK: London: National Institute for Health and Clinical Excellence, 2006.

UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes . Lancet 1998;352:837-53.

10.

Dormandy JA , Charbonnel B. , Eckland DJ et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive (PROspective pioglitAzone Clinical Trial in macroVascular Events): a randomised controlled trial. Lancet 2005;366:1279-89.

11.

Kahn SE , Haffner SM , Heise MA et al. Glycaemic durability of rosiglitazone, metformin, or glyburide monotherapy. New Engl J Med 2006; 355:2427-43.

12.

Nissen SE , Wolski K. Effect of Rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. New Engl J Med 2007 ;356:2457-71.

13.

European Medicines Agency EPARs for authorised medicinal products for human use. Available from http://www.emea.europa.eu.

14.

Hermansen K. , Davies M. , Derezinski T. et al. on behalf of the Levemir Treat-to-Target Study Group. A 26-week randomized parallel treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naïve people with type 2 diabetes. Diabetes Care 2006;29:1269-74.

15.

ACCORD ACCORD Study Announcement.Date of message February 6th, 2008 (http://www.nhlbi.nih.gov/health/prof/heart/other/accord/transcript.pdf ).

16.

ADVANCE ADVANCE Study Announcement. Date of message February 13th, 2008 (http://www.advance-trial.com/static/html/virtual/contents.asp?P=39 )

17.

Scottish Medicines Consortium. New Product Assessment Form-Exenatide 2006.

18.

Davies MJ , Khunti K. , Heller S. et al. Effects of a structured group education programme on individuals newly diagnosed with Type 2 diabetes: a cluster randomised controlled trial of the DESMOND programme BMJ 2008;336:491-5.