The National Institute for Health and Care Excellence (NICE) have issued a draft full guideline (over 270 pages in length) on lipid modification which, for patients with type 2 diabetes, would replace the current recommendations (REF 1). It recommends the UKPDS tool to assess CV risk and offer of ‘high-intensity statin treatment’ for primary prevention of CVD in people who have a 10% or greater 10-year risk. This is in contrast to the previous advice in NICE CG 66 which suggested a risk cut-off of 20% and use of simvastatin 40mg OD (now classed as ‘medium-intensity’).
Archives for April 2014
Insulin pump therapy or continuous subcutaneous insulin infusion (CSII) is a method of delivering insulin using a pager sized device which infuses insulin through a subcutaneous cannula at a variable rate depending on the patients’ blood glucose and dietary carbohydrate. As a result, it provides a degree of flexibility and control difficult to achieve with even multiple daily injections. This treatment has been around for nearly 25 years and even has its own NICE guidance (2008). There are two current criteria for CSII: – inability to gain appropriate control (A1c<69mmol/mol) or recurrent hypoglycaemia despite optimised injections. NICE guidance also describes the makeup of the specialist team required who initiate this therapy, specifically a consultant diabetologist, diabetes specialist nurse and dietician and the provision of structured education for the patients. However, despite the benefit of this treatment and comprehensive guidance, there has been concern that its provision is not as comprehensive as NICE intended. In view of this a national audit was performed in 2012 to accurately assess CSII utilisation.