NICE to see you?31 Jul 2008

An article from our bi-monthly newsletter

The National Institute for Health and Clinical Excellence have just published their new guidelines on diabetes called "The Management of Type 2 Diabetes". This replaces the previous four Guidelines curiously lettered E, F, G and H.

It is much more convenient to have the guidelines all under one roof rather than having four different ones.

It is right to say at the start that there are no surprises and the guidelines follow what is widely accepted "main line" guidance offered by other bodies such as the Scottish Intercollegiate Guidelines Network (SIGN) and the International Diabetes Federation (IDF).

With the national and indeed international guidelines being so clear and well respected, one wonders whether there is any justification spending time and, presumably, money on preparing local guidelines. These often have particular agendas either regarding high cost drugs or a wish to deter primary care professionals from carrying out certain activities such as insulin conversion.

The only oddity about the NICE guidelines is in omission rather than commission. It seems very strange that in two areas of drug therapy there is no guidance, despite the drugs concerned having been available for some time.

There are two basal analogue insulins available which have been around for roughly the same amount of time. There is detailed guidance on when to prescribe insulin glargine but none on insulin detamir.

Likewise, there are two types of incretin mimetic available: exenatide (available only as an injection) and the gliptins (available as oral preparations). There is detailed guidance on when to prescribe exenatide but none on the gliptins.

No doubt NICE have cogent reasons why no guidance in these two areas is given but the nurse or doctor working away in primary care finds it difficult to understand the reasons for these omissions in fields where important clinical decisions have to be made. A rapid update of the guidelines, due to be published in 2009, will cover these drugs.

This apart, the NICE guidelines are the "gold standard" guidance in this country and anyone not following them may well have some explaining to do.

National Institute for Health and Clinical Excellence (NICE) (2008) The Management of Type 2 Diabetes www.nice.org.uk

Scottish Intercollegiate Guidelines Network (SIGN) (2001) Guidelines 55 Magamenet of Diabetes www.sign.ac.uk

International Diabetes Federation (IDF) (2005) Global Guidelines for Type 2 Diabetes. www.idf.org