NICE work if you can get it.

NICE, in its infinite, government-financed wisdom is in the process of updating its Guidelines on the management of Type 2 Diabetes.

A consultation document has already ruffled some feathers among consultants who have felt driven to use “no,no” phrases such as “common sense” and “clinical judgement”.  At the Training Centre, we have backed common sense and clinical judgement for a long time.

The big problem appears to be on the pharmaceutical management of glycaemic control.  No one could avoid recommending metformin as first line but, after that, things go a bit awry.  Repaglinide is recommended strongly when it has just the same problems with weight gain and hypoglycaemia as traditional sulphonylureas.  Pioglitazone is also strongly recommended; not surprising as it has come off patent and is as cheap as anything.  Likewise isophane insulin, which has a far worse hypoglycaemia profile than analogue insulins but is much cheaper.

We have always advocated at the Training Centre that the first thing to do when faced with new guidelines is to ask, “who paid for them?”  This opinion dates back about ten years when two guidelines on Type 2 diabetes appeared, one sponsored by a TZD company and the other by an insulin company.  It was hardly surprising that the first recommended early use of TZD’s and the other the early use of insulin.  What was surprising was that both guidelines had the same Chairperson !

NICE (2015) Type 2 diabetes guideline consultation at www.nice.org.uk
O’Hare J P, Miller-Jones D et al (2015) The new NICE guidelines for type 2 diabetes – a critical analysis Br J Diabetes Vasc Dis 15
Inzucchi S E, Berganstal R M et al (2015) Management of hyperglycaemia in type 2 diabetes, a patient centered approach Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes , Diabetes Care 38 140-149

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